SGLT2 Inhibitors and the Risk of Contrast-Associated Nephropathy Following Angiographic Intervention: Contradictory Concepts and Clinical Outcomes

Abstract

The use of SGLT2 inhibitors (SGLT2is) has been found in large clinical studies to slow the progression of chronic kidney disease (CKD) and to lower the risk of acute kidney injury (AKI). Recent reports suggest that SGLT2is may also reduce the likelihood of developing radiocontrast-associated nephropathy (CAN) following contrast-enhanced imaging and intravascular interventions. This review underscores potential pitfalls and confounders in these studies and calls for caution in adopting their conclusions regarding the safety and renoprotective potency of SGLT2is, in particular in patients at high risk, with advanced CKD and hemodynamic instability undergoing coronary intervention. This caution is particularly warranted since both SGLT2is and contrast media intensify medullary hypoxia in the already hypoxic diabetic kidney and their combination may lead to medullary hypoxic damage, a principal component of CAN. Further studies are needed to evaluate this dispute, particularly in patients at high risk, and to reveal whether SGLT2is indeed provide renal protection or are hazardous during contrast-enhanced imaging and vascular interventions.

Keywords: SGLT2i; chronic kidney disease; coronary interventions; hypoxia; radiocontrast nephropathy.

Figure 1

Suggested integrated impact of diabetes mellitus (DM), iodinated contrast medium (CM) and SGLT2 inhibitors (SGLT2is) on renal parenchymal oxygenation, oxidative stress and injury and a plausible SGLT2i-mediated renal protection through myocardial salvage. HIF—hypoxia-inducible factor 2; PO2—partial oxygen pressure.