Short term sodium glucose transport protein 2 inhibitors are associated with post contrast acute kidney injury in patients with diabetes

Abstract

Although sodium-glucose transport protein-2 (SGLT2) inhibitors (SGLT2i) do not increase the risk of acute kidney injury (AKI) in general, they may pose a risk in patients undergoing angiography. This prospective cohort study aimed to evaluate the safety and efficacy of SGLT2i for post-contrast AKI (PC-AKI) in patients with type 2 diabetes mellitus (T2DM). Following screening, 306 patients with T2DM selected to undergo coronary arterial angiography with or without percutaneous intervention were enrolled. Patients were divided into the SGLT2i exposure and non-exposure groups. The primary outcome was PC-AKI, defined as an increase in serum creatinine levels > 0.5 mg/dL (44.2 µmol/L), or 25% above the baseline, within 48-72 h after exposure to contrast medium. The incidence of PC-AKI in the overall T2DM population was 5.2% (16/306). Following 1:1 propensity score matching, the incidence of PC-AKI was significantly higher in the SGLT2i group than in the non-SGLT2i group (10.7% vs. 2.9%; P = 0.027), with an odds ratio of 4.5 (95% confidence interval: 1.0-20.2; P = 0.047). Furthermore, PC-AKI occurred at a higher rate among short-term users of SGLT2i than long-term users (20.5% vs. 3.4%, P = 0.018). Thus, our findings suggest an increased risk of PC-AKI associated with short-term SGLT2i therapy in patients with T2DM.

Keywords: Estimated glomerular filtration rate; Post-contrast acute kidney injury; SGLT2 inhibitors; Serum creatinine; Type 2 diabetes mellitus.

Fig. 1

Flowchart. T2DM type 2 diabetes mellitus, eGFR estimated glomerular filtration rate, SGLT2i sodium–glucose transport protein-2 inhibitors.

Fig. 2

Endpoints. (A), the incidence of PC-AKI was significantly higher in the SGLT2i group than in the Non-SGLT2i group (10.7% vs. 2.9%, P = 0.027). (B), the incidence of PC-AKI was significantly higher in the post-admission short-term SGLT2i therapy group than in the preadmission long-term SGLT2i therapy group (20.5% vs. 3.4%, P = 0.018). (C), no significant difference in the proportion of patients with ∆Cys-c ≥ 10% after angiography between the two groups (16.5% vs. 11.7%; P = 0.371). (D), the proportion of patients with ∆Cys-c ≥ 10% was significantly higher in the post-admission short-term SGLT2i therapy group than in the preadmission long-term SGLT2i therapy group (27.3% vs. 8.5%, P = 0.011). ∆Cys-c ≥ 10% was defined as a post-operative increase in Cys-c levels ≥ 10% from baseline values within 48 h. SGLT2i sodium–glucose transport protein-2 inhibitors, PC-AKI postcontrast acute kidney injury, PSM propensity score matching.

Fig. 3

Comparative odds ratios of PC-AKI between SGLT2i group and Non-SGLT2i group. ∆Cys-c ≥ 10% was defined as a post-operative increase in Cys-c levels ≥ 10% from baseline values within 48 h. OR odds ratios, CI confidence interval, SGLT2i sodium–glucose transport protein-2 inhibitors, PC-AKI postcontrast acute kidney injury, Cys-c cystatin c.