Tip 2 Diyabetli Hastalarda SGLT2 İnhibitörlerinin Kullanımı ile Kontrast Maddeye Bağlı Akut Böbrek Hasarı Riski Arasındaki İlişki

Year 2025, Volume: 8 Issue: 2, 129 - 133, 30.06.2025

Hüseyin Ali Öztürk , Erdinc Gulumsek , Dilan Damla Ozturk , Fatih Necip Arıcı , Begüm Şeyda Avci , Bektaş Işık , Mehmet Can Erişen , Berçem Berent Kaya , İrfan Alişan , Cahit Dincer , Ahmet Gazi Mustan , Cisem Yilmaz , Tayyibe Saler , Hilmi Erdem Sümbül

https://doi.org/10.36516/jocass.1654263

Abstract

Amaç: Kontrast kaynaklı akut böbrek hasarı (CI-AKI) morbidite ve mortalite riskinin artmasıyla ilişkili olup spesifik tedavilere ihtiyaç duyulmaktadır. Çalışmamızda DM tanılı hastalarda Sodyum-glikoz kotransporter-2 inhibitörleri (SGLT2-I) kullanımının koroner anjiografiye (KAG) bağlı CI-AKI gelişimi ile ilişkisini araştırmayı amaçladık.
Metod: Retrospektif ve kesitsel çalışmamıza elektif endikasyonlar nedeniyle KAG planlanan 250'si SGLT2-I kullanan ve 266'sı SGLT2-I kullanmayan olmak üzere toplam 516 tip 2 diyabetes mellitus (DM) hastası dahil edildi.
Bulgular: Çalışma grupları CI-AKI (+) ve CI-AKI (-) olmak üzere ikiye ayrıldı. SGLT2-I kullanımı CI-AKI (-) olan grupta istatistiksel anlamlı olarak daha yüksekti. Çok değişkenli lojistik regresyon analizinde, SGLT2-I kullanımının CI-AKI olma olasılığını 83.8% azalttığı saptandı.
Sonuç: Bulgularımız, SGLT2-I'lerin KAG geçiren diyabetli hastalarda CI-AKI riskini önemli ölçüde azaltabileceğini göstermektedir. Sonuç olarak SGLT2-I kullanımı CI-AKI gelişimine karşı koruyucu ve önleyici bir etkinliğe sahip olabilir.

Keywords

kontrast maddeye bağlı akut böbrek hasarı, koroner anjiografi, diyabetes mellitüs, perkütan koroner girişim, sodyum-glikoz kotransporter-2 inhibitörleri

The Association between SGLT2 Inhibitors Use and the Risk of Contrast Induced Acute Kidney Injury in Patients with Type 2 Diabetes

Abstract

Aim: Contrast-induced acute kidney injury (CI-AKI) is associated with increased risk of morbidity and mortality and specific treatments are needed. In our study, we aimed to investigate the association of sodium-glucose cotransporter-2 inhibitors (SGLT2-I) use with the development of CI-AKI due to coronary angiography (CAG) in patients with DM.
Methods: A total of 516 type 2 diabetes mellitus (DM) patients, including 250 SGLT2-I users and 266 non-SGLT2-I users, were included in our retrospective and cross-sectional study.
Results: The study groups were divided into CI-AKI (+) and CI-AKI (-). SGLT2-I use was statistically significantly higher in the CI-AKI (-) group. Multivariate logistic regression analysis showed that SGLT2-I use reduced the probability of CI-AKI by 83.8%.
Conclusion: Our findings suggest that SGLT2-Is may significantly reduce the risk of CI-AKI in diabetic patients undergoing CAG. In conclusion, the use of SGLT2-I may have a protective and preventive effect against the development of CI-AKI.

Keywords

contrast induced acute kidney injury, coroner angiography, diabetes mellitus, percutaneous coronary intervention, sodium-glucose cotransporter-2 inhibitors

References

• 1. Kusirisin P, Chattipakorn SC, Chattipakorn N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches. J Transl Med. 2020;18:400. [Crossref]
• 2.Chalikias G, Drosos I, Tziakas DN. Contrast-induced acute kidney injury: an update. Cardiovasc Drugs Ther. 2016;30:215-28. [Crossref]
• 3.Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med. 2019;380:2146-55. [Crossref]
• 4.Zhang F, Lu Z, Wang F. Advances in the pathogenesis and prevention of contrast-induced nephropathy. Life Sci. 2020;259:118379. [Crossref]
• 5.Maestro C, Leache L, Gutiérrez-Valencia M, Saiz LC, Gómez H, Bacaicoa MC, et al. Efficacy and safety of N-acetylcysteine for preventing post-intravenous contrast acute kidney injury in patients with kidney impairment: a systematic review and meta-analysis. Eur Radiol. 2023;33:6569-81. [Crossref]
• 6.Li H, Wang C, Liu C, Li R, Zou M, Cheng G. Efficacy of short-term statin treatment for the prevention of contrast-induced acute kidney injury in patients undergoing coronary angiography/percutaneous coronary intervention: a meta-analysis of 21 randomized controlled trials. Am J Cardiovasc Drugs. 2016;16:201-19. [Crossref]
• 7.Mosenzon O, Wiviott SD, Cahn A, Rozenberg A, Yanuv I, Goodrich EL, et al. Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial. Lancet Diabetes Endocrinol. 2019;7:606-17. [Crossref]
• 8.Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380:347-57. [Crossref]
• 9.Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-46. [Crossref]
• 10.Herrington WG, Staplin N, Wanner C, Green JB, Hauske SJ, Emberson JR, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;388:117-27. [Crossref]
• 11.Oe Y, Vallon V. The pathophysiological basis of diabetic kidney protection by inhibition of SGLT2 and SGLT1. Kidney Dial. 2022;2:349-68. [Crossref]
• 12.Sternlicht HK, Bakris GL. Reductions in albuminuria with SGLT2 inhibitors: a marker for improved renal outcomes in patients without diabetes? Lancet Diabetes Endocrinol. 2020;8:553-5. [Crossref]
• 13.Paolisso P, Bergamaschi L, Gragnano F, Gallinoro E, Cesaro A, Sardu C, et al. Outcomes in diabetic patients treated with SGLT2-inhibitors with acute myocardial infarction undergoing PCI: the SGLT2-I AMI PROTECT Registry. Pharmacol Res. 2023;187:106597. [Crossref]
• 14.Özkan U, Gürdoğan M. The effect of SGLT2 inhibitors on the development of contrast-induced nephropathy in diabetic patients with non-ST segment elevation myocardial infarction. Medicina (Kaunas). 2023;59:505. [Crossref]
• 15.Feitosa MPM, Lima EG, Abizaid AAC, Mehran R, Lopes NHM, de Assis Fischer Ramos T, et al. The safety of SGLT-2 inhibitors in diabetic patients submitted to elective percutaneous coronary intervention regarding kidney function: SAFE-PCI pilot study. Diabetol Metab Syndr. 2023;15:138. [Crossref]
• 16.American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:S62-9. [Crossref]
• 17.Liu T, Jian X, Li L, Chu S, Fan Z. The association between dapagliflozin use and the risk of post-contrast acute kidney injury in patients with type 2 diabetes and chronic kidney disease: a propensity-matched analysis. Kidney Blood Press Res. 2023;48:752-60. [Crossref]
• 18.Li Y, Ren K. The mechanism of contrast-induced acute kidney injury and its association with diabetes mellitus. Contrast Media Mol Imaging. 2020;2020:3295176. [Crossref]
• 19.Gajewska A, Wasiak J, Sapeda N, Młynarska E, Rysz J, Franczyk B. SGLT2 inhibitors in kidney diseases—a narrative review. Int J Mol Sci. 2024;25:4959. [Crossref]
• 20.Nadkarni GN, Ferrandino R, Chang A, Surapaneni A, Chauhan K, Poojary P, et al. Acute kidney injury in patients on SGLT2 inhibitors: a propensity-matched analysis. Diabetes Care. 2017;40:1479-85. [Crossref]
• 21.Huang X, Guo X, Yan G, Zhang Y, Yao Y, Qiao Y, et al. Dapagliflozin attenuates contrast-induced acute kidney injury by regulating the HIF-1α/HE4/NF-κB pathway. J Cardiovasc Pharmacol. 2022;79:904-13. [Crossref]
• 22.Hua R, Ding N, Guo H, Wu Y, Yuan Z, Li T. Contrast-induced acute kidney injury in patients on SGLT2 inhibitors undergoing percutaneous coronary interventions: a propensity-matched analysis. Front Cardiovasc Med. 2022;9:918167. [Crossref]
• 23.Hosseini ZS, Jamili MJ, Ensan B, Donyadideh G, Shahri B, Eshraghi H, et al. Short-term effects of empagliflozin on preventing contrast induced acute kidney injury in patients undergoing percutaneous coronary intervention, a randomised trial. Sci Rep. 2025;15:3940. [Crossref]
• 24.Meregildo-Rodriguez ED, Asmat-Rubio MG, Vásquez-Tirado GA. SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14:1307715. [Crossref]
• 25.Vlachopanos G, Schizas D, Hasemaki N, Georgalis A. Pathophysiology of contrast-induced acute kidney injury (CIAKI). Curr Pharm Des. 2019;25:4642-7. [Crossref]