Reno-Protective Effects of SGLT2 Inhibitors in Patients With Diabetes Undergoing Percutaneous Coronary Intervention: Insights From the BMC2 Registry

BACKGROUND: Chronic therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with long-term reno-protective benefits. There are limited data on the benefits of these agents against the risk of contrast-associated acute kidney injury (CA-AKI). METHODS: The retrospective study population included all patients with diabetes enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Percutaneous Coronary Intervention registry, a clinical registry of all percutaneous coronary intervention (PCI) cases at nonfederal hospitals in the state of Michigan. Included patients underwent PCI between January 2022 and September 2023. Patients on dialysis and those without post-PCI serum creatinine measurements were excluded. SGLT2i users were compared with nonusers with respect to CA-AKI outcomes, defined as an increase in serum creatinine of ≥0.5 mg/dL following PCI. Outcomes were evaluated in a risk-adjusted, propensity-matched analysis. RESULTS: Among 13 804 patients with diabetes who underwent PCI, CA-AKI occurred in 3.8% (82/2186) of SGLT2i users versus 5.2% (602/11 618) of nonusers (odds ratio, 0.71; P =0.004). In propensity-matched, risk-adjusted analysis, the pre-PCI use of SGLT2i correlated with a lower incidence of CA-AKI (3.69% versus 4.68%; adjusted odds ratio, 0.72; P =0.027). The protective effect of SGLT2i was preserved among higher-risk subgroups. CONCLUSIONS: Among patients with diabetes who underwent PCI, preprocedural use of SGLT2i correlated with a lower risk of CA-AKI.