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

Yıl 2025, Cilt: 6 Sayı: 4, 305 - 310, 31.08.2025

Arzu Akgül , Çağatay Tunca , Mehmet Deniz Aylı

https://doi.org/10.47582/jompac.1697010

Öz

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.

Anahtar Kelimeler

kontrast nefropati , diyabetes mellitus , metformin

Proje Numarası

Date: 29.04.2025, Decision No: AEŞH-BADEK2-2025-012

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

Öz

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.

Anahtar Kelimeler

Contrast-induced nephropathy , metformin , diabetes mellitus

Etik Beyan

Written informed consent was obtained from all patients. To ensure data confidentiality, all personal identifiers were removed and anonymized data were stored in secure, password-protected electronic databases accessible only to the study team. The study was conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines.

Proje Numarası

Date: 29.04.2025, Decision No: AEŞH-BADEK2-2025-012

Kaynakça

• McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51(15):1419-1428. doi:10.1016/j.jacc.2007.12.035
• Abdel-Kader K, Palevsky PM. Acute kidney injury in the elderly. Clin Geriatr Med. 2009;25(3):331-358. doi:10.1016/j.cger.2009.04.001
• Heyman SN, Rosen S, Khamaisi M, Idée JM, Rosenberger C. Reactive oxygen species and the pathogenesis of radiocontrast-induced nephropathy. Invest Radiol. 2010;45(4):188-195. doi:10.1097/RLI.0b013 e3181cf2544
• Nikolsky E, Mehran R, Lasic Z, et al. Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int. 2005;67(2):706-713. doi:10.1111/j.1523-1755.2005.67120.x
• Lalau JD, Race JM. Lactic acidosis in metformin therapy: searching for a link with metformin in reports of 'metformin-associated lactic acidosis'. Diabetes Obes Metab. 2001;3(3):195-201. doi:10.1046/j.1463-1326.2001. 00233.x
• Lee EY, Hwang S, Lee YH, et al. Association between metformin use and risk of lactic acidosis or elevated lactate concentration in type 2 diabetes. Yonsei Med J. 2017;58(2):312-318. doi:10.3349/ymj.2017.58.2.312
• Hu Y, Lei M, Ke G, et al. Metformin use and risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease---a systematic review and meta-analysis. Front Endocrinol. 2020;11:559446. doi:10.3389/fendo.2020.559446
• Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia. 2017;60(9):1577-1585. doi:10.1007/s00125-017-4342-z
• Zhang Z, Dong H, Chen J, Yin M, Liu F. Effects of metformin on renal function, cardiac function, and inflammatory response in diabetic nephropathy and its protective mechanism. Dis Markers. 2022:2022: 8326767. doi:10.1155/2022/8326767
• Crowley MJ, Diamantidis CJ, McDuffie JR, et al. Metformin use in patients with historical contraindications or precautions. Washington (DC): Department of Veterans Affairs (US); 2016.
• Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393-1399. doi:10.1016/j.jacc.2004.06.068
• Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499-511. doi:10.1161/01.cir.0000052939.59093.45
• American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15-S33. doi:10.2337/dc21-S002
• Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1-150.
• Oktay V, Calpar Çıralı İ, Sinan ÜY, Yıldız A, Ersanlı MK. Impact of continuation of metformin prior to elective coronary angiography on acute contrast nephropathy in patients with normal or mildly impaired renal functions. Anatol J Cardiol. 2017;18(5):334-339. doi:10.14744/AnatolJCardiol.2017.7836
• Corremans R, Vervaet BA, Dams G, D'Haese PC, Verhulst A. Metformin and canagliflozin are equally renoprotective in diabetic kidney disease but have no synergistic effect. Int J Mol Sci. 2023;24(10):9043. doi:10. 3390/ijms24109043
• 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(3):505. doi:10.3390/medicina59030505
• González-González JG, Solis RC, Díaz González-Colmenero A, et al. Effect of metformin on microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2022;186:109821. doi:10.1016/j.diabres.2022.109821
• Yang H, Yang L, Jardine MJ, et al. The association between sodium-glucose cotransporter 2 inhibitors and contrast-associated acute kidney injury in patients with type 2 diabetes undergoing angiography: a propensity-matched study. Eur J Med Res. 2024;29(1):621. doi:10.1186/s40001-024-02214-7
• Lee PH, Huang SM, Tsai YC, Wang YT, Chew FY. Biomarkers in contrast-induced nephropathy: advances in early detection, risk assessment, and prevention strategies. Int J Mol Sci. 2025;26(7):2869. doi:10.3390/ijms26072869
• Ma K, Qiu H, Zhu Y, Lu Y, Li W. Preprocedural SII combined with high-sensitivity C-reactive protein predicts the risk of contrast-induced acute kidney injury in STEMI patients undergoing percutaneous coronary intervention. J Inflamm Res. 2022;15:3677-3687. doi:10.2147/JIR.S370085
• Abdel-Ghany M, Morsy G, Kishk YT. Predictors of contrast-induced nephropathy in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Egypt J Intern Med. 2021; 33(1):16. doi:10.1186/s43162-021-00043-2
• Su S, Zhou L, Li L, et al. Association between hematocrit and acute kidney injury in patients with acute myocardial infarction. Rev Cardiovasc Med. 2024;25(6):228. doi:10.31083/j.rcm2506228
• Çetin M, Acehan F, Kundi H, et al. A novel risk prediction tool for contrast-induced nephropathy in patients with chronic kidney disease who underwent diagnostic coronary angiography. Eur Rev Med Pharmacol Sci. 2023;27(9):3430-3437. doi:10.26355/eurrev_202304_32113
• Li Y, Wang J. Contrast-induced acute kidney injury: a review of definition, pathogenesis, risk factors, prevention and treatment. BMC Nephrol. 2024;25(1):140. doi:10.1186/s12882-024-03570-6
• Lee K, Jung W, Jeon J, et al. Prediction of contrast-associated acute kidney injury with machine-learning in patients undergoing contrast-enhanced computed tomography in emergency department. Sci Rep. 2025;15(1):7088. doi:10.1038/s41598-025-86933-9
• Ng AKY, Ng PY, Ip A, et al. Impact of contrast-induced acute kidney injury on long-term major adverse cardiovascular events and kidney function after percutaneous coronary intervention: insights from a territory-wide cohort study in Hong Kong. Clin Kidney J. 2022;15(2):338-346. doi:10.1093/ckj/sfab212
• Hwang J, Kim M. Risk factors for contrast-induced nephropathy in patients undergoing elective coronary angiography in Taiwan: a multicenter analysis. Sriwijaya J Int Med. 2023;1(1):1-10. doi:10.59345/sjim.v1i1.16
• Beasley M, Broce M, Mousa A. The acute impact of baseline renal function and contrast medium volume/estimated glomerular filtration rate ratio on reduced renal function following endovascular abdominal aortic aneurysm repair. Vascular. 2023;31(1):72-82. doi:10.1177/ 17085381211059660
• Chang-Panesso M. Acute kidney injury and aging. Pediatr Nephrol. 2021;36(10):2997-3006. doi:10.1007/s00467-020-04849-0
• Takura T, Nitta K, Tsuchiya K, Kawanishi H. Long-term effects of contrast media exposure on renal failure progression: a retrospective cohort study. BMC Nephrology. 2023;24(1):135. doi:10.1186/s12882-023-03194-2