Protective Effect of Sglt2 Inhibitors on Post-contrast Medium Induced Acute Kidney Injury in Diabetic Patients

Introduction : Patients with type 2 diabetes mellitus (T2DM) are at high risk of coronary artery disease, and an increasing number of coronary angiography and interventional procedures are being performed in this population. In addition, many studies have identified risk factors for contrast-induced acute kidney injury, yet effective preventive measures remain limited. Methods : We conducted a multicenter observational cohort study including 975 T2DM patients who underwent coronary artery imaging or percutaneous coronary intervention with iodinated contrast media at three tertiary hospitals between June 2023 and June 2024. Patients were 18–75 years old with baseline estimated glomerular filtration rate (eGFR) 25–115 mL/min/1.73 m². All procedures were performed according to standard practice, with all patients receiving intravenous 0.9% saline at 1 mL/kg/hour for 6 hours before and 12 hours after the procedure as prophylactic hydration. Results : Overall, 71 of 975 patients (7.3%) developed post-contrast acute kidney injury (PC-AKI). Among patients who were users of sodium–glucose co-transporter 2 (SGLT2) inhibitors, only 4 patients (2.4%) developed PC-AKI, compared to 9.0% in those not using SGLT2 inhibitors. None of the SGLT2 inhibitor users who developed PC-AKI required hospitalization or dialysis. The incidence of PC-AKI was significantly lower in the SGLT2 inhibitor group than in the non-user group (p < 0.05). Conclusion : SGLT2 inhibitors are a relatively new class of glucose-lowering drugs with proven long-term cardioprotective and renoprotective effects. In addition to these established benefits, SGLT2 inhibitors appear to protect against PC-AKI in patients with T2DM, possibly by reducing renal oxygen consumption and mitigating contrast-induced hypoxic injury.