The Impact of Dapagliflozin on the Incidence of Contrast-induced Nephropathy in Patients with Type 2 Diabetes Mellitus Underwent Percutaneous Coronary Intervention

Abstract

Background Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus (T2DM), which can also reduce the risk of nephropathy progression, decrease urinary protein and protect the heart. However, whether dapagliflozin can reduce the incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in T2DM patients remain unclear. Objective To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI. Methods According to the principle of 1∶1 propensity matching based on the use of dapagliflozin, a total of 484 T2DM patients who underwent PCI in the Department of Cardiology, Tianjin Chest Hospital from 2021 to 2023 were retrospectively consecutively enrolled in the study, of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared, and the renal functions of the two groups were recorded before PCI, 48 hours after PCI and 1 week after PCI, including blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), cystatin C (Cys-C), β2- microglobulin (β2-MG), and neutrophil gelatinase associated apolipoprotein (NGAL). The primary study endpoint was the incidence of CIN, and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM. Results The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group (12.0%). The difference was statistically significant (χ2=4.900, P=0.039). The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group (P<0.05). There was no statistically significant difference in BUN, Scr, Ccr, Cys-C, β2-MG, and NGAL levels between 2 groups before and 1 week after PCI (P>0.05). At 48 hours after PCI, the levels of Cys-C, β2-MG, and NGAL in the dapagliflozin group were lower than those in the control group (P<0.05). Multivariate Logistic regression analysis showed that high CIN risk score (OR=1.213, 95%CI=1.085-1.358, P=0.001) and B-type natriuretic peptide levels (OR=3.940, 95%CI=1.479-10.494, P=0.006) were independent risk factors for CIN after PCI in patients with T2DM, and the use of dapagliflozin (OR=0.338, 95%CI=0.159-0.717, P=0.005) was an independent protective factor for the development of CIN after PCI in patients with T2DM. Conclusion The use of dapagliflozin is an independent protective factor against the development of CIN after PCI in patients with T2DM, and dapagliflozin does not increase the risk of developing acute kidney injury after PCI in patients with T2DM and may reduce the incidence of CIN.

Keywords

• diabetes mellitus, type 2|acute kidney injury|dapagliflozin|contrast materials|percutaneous coronary intervention|root cause analysis