Koroner anjı̇yografı̇ yapılan dı̇yabetı̇k hastalarda metformı̇n kullanımı ı̇le kontrasta bağlı nefropatı̇ arasındakı̇ ı̇lı̇şkı̇

Abstract

Amaç: Bu çalışmada, metformin kullanımının koroner anjiyografi uygulanan tip 2 diyabetik hastalarda kontrast indüklü nefropati (CIN) gelişimi üzerine etkisini incelemeyi amaçladık. Yöntem: Kasım 2022-Aralık 2024 tarihleri arasında akut koroner sendrom tanısıyla koroner anjiyografi uygulanan 398 diyabetik hasta (metformin kullanan n=122, kullanmayan n=276) çalışmaya dahil edildi. Hastalar demografik, klinik ve laboratuvar özellikleri açısından karşılaştırıldı. CIN, işlemden sonraki 48 saat içinde serum kreatinin seviyesinde bazal değere göre %25 veya ≥0.5 mg/dL artış olarak tanımlandı. Tüm hastalara işlem öncesi oral hidrasyon ve sonrasında intravenöz sıvı uygulandı. Bulgular: Metformin kullanan grupta CIN gelişme oranı %6.6 iken, kullanmayan grupta %20.3 olarak saptandı (p=0.001). Ortalama kontrast madde hacmi metformin kullanan grupta 290.0 mL [220.0-320.0], kullanmayan grupta 280.0 mL [210.0-310.0] olarak saptandı (p=0.095). Çok değişkenli lojistik regresyon analizinde metformin kullanımının CIN gelişme riskini anlamlı şekilde azalttığı gösterildi (OR: 0.31, %95 CI: 0.14-0.69, p=0.004). Diğer bağımsız risk faktörleri arasında 65 yaş üstü olmak (OR: 2.43, p<0.001), GFR<60 mL/dk/1.73m² (OR: 2.48, p<0.001), CRP>10 mg/L (OR: 2.12, p<0.001) ve hemoglobin<12 g/dL (OR: 1.92, p<0.001) yer aldı. Sonuç: Metformin kullanımı, koroner anjiyografi uygulanan diyabetik hastalarda CIN gelişme riskini önemli ölçüde azaltmaktadır. Bu bulgular, metforminin kontrast prosedürler öncesinde rutin olarak kesilmesi yaklaşımının yeniden değerlendirilmesi gerektiğini göstermektedir.

Keywords

• kontrast nefropati
• diyabetes mellitus
• metformin

The association between metformin use and contrast-induced nephropathy in diabetic patients undergoing coronary angiography

Abstract

Aims: Contrast-induced nephropathy (CIN) is a significant cause of hospital-acquired acute kidney injury, particularly in patients with diabetes mellitus undergoing coronary angiography. Although metformin is a widely prescribed antidiabetic agent, its role in CIN prevention remains controversial. This study aimed to investigate the impact of metformin use on the development of CIN in diabetic patients undergoing coronary angiography. Methods: This retrospective cohort study included 398 diabetic patients undergoing coronary angiography with a diagnosis of acute coronary syndrome between November 2022 and December 2024. Patients were classified into two groups based on metformin use (metformin group, n=122; non-metformin group, n=276). CIN was defined as a ≥25% or ≥0.5 mg/dl increase in serum creatinine within 48 hours post-procedure. Demographic, clinical, laboratory, and procedural data were analyzed. Multivariate logistic regression was used to identify independent predictors of CIN. Results: CIN occurred in 6.6% of patients in the metformin group and 20.3% in the non-metformin group (p=0.001). Metformin use was independently associated with a lower risk of CIN (OR: 0.31; 95% CI: 0.14–0.69; p=0.004) in the multivariate logistic regression analysis. Other independent predictors of CIN included age >65 years, chronic kidney disease, high glucose, hemoglobin, CRP, smoking, and contrast volume. Conclusion: Metformin use is does not increase the risk of CIN in diabetic patients undergoing coronary angiography. These findings support the potential renoprotective effect of metformin and question the necessity of routinely discontinuing it before contrast administration in patients with preserved renal function.

Keywords

• Contrast-induced nephropathy
• metformin
• diabetes mellitus

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