Hypoglycemic agents and contrast-induced acute kidney injury in type 2 diabetes: A retrospective cohort study of patients undergoing coronary angiography or percutaneous coronary intervention.

ObjectiveTo investigate the association between different classes of hypoglycemic agents and the occurrence of contrast-induced acute kidney injury (CIAKI) in patients with type 2 diabetes mellitus (T2DM) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).MethodsThis retrospective cohort study included 2082 patients with T2DM who underwent CAG or PCI at two tertiary hospitals between January 2020 and December 2022. Patients were categorized into CIAKI and non-CIAKI groups, and baseline characteristics and short-term in-hospital outcomes were compared. The effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) use and other classes of glucose-lowering agents on the incidence of CIAKI were evaluated. Multivariable logistic regression analysis was performed to identify factors associated with the occurrence of CIAKI. Propensity score matching was further applied to assess the associations between different glucose-lowering agents and CIAKI as well as adverse cardiovascular outcomes.ResultsThe incidence of CIAKI was 11.7% (244/2082). Patients with CIAKI had significantly worse short-term in-hospital outcomes. In multivariable logistic regression analysis, SGLT2i use (OR = 1.892, P = 0.040), total cholesterol (OR = 1.494, P = 0.002), elevated blood urea nitrogen (OR = 1.082, P = 0.022), and diuretic use (OR = 3.389, P < 0.001) were associated with an increased risk of CIAKI. After propensity score matching, SGLT2i use remained associated with a higher incidence of CIAKI (OR = 2.384, P = 0.003), DPP4 inhibitor use was associated with a lower observed incidence of CIAKI (OR = 0.179, P = 0.027). In contrast, no statistically significant associations were observed for other glucose-lowering agents with respect to CIAKI or overall adverse cardiovascular outcomes.ConclusionsSGLT2i use may be associated with a higher incidence of CIAKI in patients with T2DM undergoing CAG or PCI. These findings may aid risk stratification and clinical management. Further research is needed to clarify the underlying mechanisms.