Protective Effect of SGLT2i on contrast-induced AKI after Angiography in Patients with Type 2 Diabetes Mellitus and Chronic Coronary Syndrome: A 6-year Ambispective Cohort Study and Meta-analysis

Background SGLT2 inhibitor (SGLT2i) may reduce the risk of contrast-induced acute kidney injury (CI-AKI) in patients with type 2 diabetes mellitus (T2DM) with chronic coronary syndrome (CCS) undergoing angiography. However, the evidence is still inconclusive. We aimed to conduct a real world study and systematically review to provide updated and larger-scale evidence. Study design : Ambispective Cohort Study and Meta-analysis. Setting & population : Patients with T2DM and CCS. Methods The data was obtained from December 2017 to July 2024. Propensity score techniques were applied to enhance between-group comparability. We analyzed CI-AKI _ESUR and CI-AKI _KDIGO and conducted subgroup analyses based on the types of angiographic procedures, including percutaneous coronary interventions (PCI), coronary arteriography (CAG), and Coronary Computed Tomographic Angiography (CCTA). We retrieved similar cohort studies from the literature to perform a meta-analysis. Results from trials reporting CI-AKI _ESUR and/or CI-AKI _KDIGO rates among patients randomized to SGLT2i versus placebo were also meta-analysed. Results A total of 2,350 patients receiving dapagliflozin and 16,251 patients did not receiving any SGLT2i were included before PSM. 2,071 SGLT2i users were matched with 2,071 control patients. The incidence of primary outcome 1 and 2 were both significant lower in SGLT2i group than in the control group, which were both confirmed before and after PSM analysis. Subgroup analysis showed that the incidence of CI-AKI in the SGLT2i group was significantly lower after either PCI, CAG or CCTA. The meta-analysis of cohort studies further confirmed this result, that is, the rate of CI-AKI occurrence after angiography in the SGLT2i group was significantly lower than in the control group regardless of which criterion for CI-AKI was used. Limitations Results may be limited by single-center nature, inevitable sample selection bias, etc. and subgroup analysis of angiography operation types was conducted. Conclusion In real-world T2DM patients, SGLT2i was associated with lower CI-AKI risk. Clinical trial registration : Chinese Clinical Trial Registry, identifier: ChiCTR2300076484