In diabetic patients with chronic kidney disease undergoing TAVI, SGLT2 inhibitors were associated with lower contrast-induced acute kidney injury (8.5% vs 19.8%; OR 0.66, 95% CI 0.37-0.88).
Observational (n=514)
Yes
Does SGLT2 inhibitor therapy reduce contrast-induced acute kidney injury in diabetic patients with severe aortic stenosis undergoing TAVI?
In diabetic patients with chronic kidney disease undergoing TAVI, SGLT2 inhibitor therapy is associated with a significantly lower risk of contrast-induced acute kidney injury.
Odds Ratio: 0.66 (95% CI 0.37–0.88)
Absolute Event Rate: 8.5% vs 19.8%
p-value: p=0.006
Abstract Background Contrast-induced acute kidney injury (CI-AKI) in patients undergoing TAVI has been shown to significantly worsen outcomes, increasing both short- and long-term mortality rates. Currently, the impact of SGLT2i on CI-AKI occurrence in diabetic patients with severe AS undergoing TAVI is still largely unknown, especially in patients with CKD. Aims To evaluate the risk of contrast-induced acute kidney injury (CI-AKI) in patients with type 2 diabetes mellitus (T2DM) and severe aortic stenosis (AS) undergoing trans catheter aortic valve implantation (TAVI), comparing those treated with SGLT2 inhibitors (SGLT2i users) to those receiving other anti diabetic agents (no-SGLT2 users), stratified by the presence of chronic kidney disease (CKD). Methods Multicenter international registry of consecutive T2DM patients with severe AS undergoing TAVI between 2021-2024. CKD was defined as eGFR 60 ml/min/m2, according to the KDIGO Guideline. The study population was stratified by the presence of CKD and anti-diabetic therapy at hospital admission (SGLT2i versus no-SGLT2i users). Results The study population consisted of 514 patients, stratified into those without CKD (n=226, 44%), of whom 43 (19%) were treated with SGLT2i, and 288 (56%) with CKD, of whom 71 (24.7%) were SGLT2i users. The median age was 81 77-84 years and 60.1% were males. SGLT2i use did not impact renal function in non-CKD patients, with CI-AKI occurring in 7.1% of the cases, independently of SGLT2i use. Among CKD patients, CI-AKI occurred more frequently in no-SGLT2i users compared to those receiving SGLT2i (19.8% versus 8.5%, p=0.027), with a significant rise in post-TAVI and discharge serum creatinine values for non-SGLT2i users (p=0.001 after TAVI and p0.001 at hospital discharge). Only in the CKD group, the use of SGLT2i was identified as an independent predictor of lower rate of CI-AKI occurrence (OR 0.66, 95%CI 0.37-0.88, p = 0.006). Patients who developed CI-AKI had a higher incidence of major adverse cardiovascular events (MACE) during follow-up, independently of CKD (p0.025 for both) (Figure 1). Conclusion In diabetic patients with CKD undergoing TAVI, SLGT2i therapy was associated with lower occurrence of CI-AKI compared to those not treated with SGLT2i, suggesting a potential nephroprotective effect in this population.Figure 1
Vincelli et al. (Sat,) conducted a observational in Type 2 diabetes mellitus and severe aortic stenosis (n=514). SGLT2 inhibitors vs. Other anti-diabetic agents (no-SGLT2i users) was evaluated on Contrast-induced acute kidney injury (CI-AKI) in patients with chronic kidney disease (OR 0.66, 95% CI 0.37-0.88, p=0.006). In diabetic patients with chronic kidney disease undergoing TAVI, SGLT2 inhibitors were associated with lower contrast-induced acute kidney injury (8.5% vs 19.8%; OR 0.66, 95% CI 0.37-0.88).