Contrast-induced Acute Kidney Injury in Diabetic Patients and SGLT-2 Inhibitors: A Preventive Opportunity or Promoting Element?

Abstract

Contrast-induced acute kidney injury (CI-AKI) is a serious complication in patients undergoing diagnostic or therapeutic procedures that require contrast use and negatively affects the long-term outcomes. Patients with type 2 diabetes mellitus (DM), particularly those who have already developed diabetic nephropathy (DN), are more susceptible to contrast-induced renal damage. Indeed, contrast media amplify some pathological molecular and cellular pathways already in place in the DN setting. In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have triggered a paradigm shift in managing patients with type 2 DM, reducing cardiovascular and renal adverse events, and slowing DN development. Some evidence also suggests favorable effects of SGLT2i on acute kidney injury despite the initial alarm; however, little data exist regarding CI-AKI. The present review provides an updated overview of the most recent experimental and clinical studies investigating the beneficial effects of SGLT2i on chronic and acute renal injury, focusing on their potential role in the development of CI-AKI. Thus, we aimed to expand the clinicians' understanding by underscoring new opportunities to prevent this complication in the setting of DM, where effective preventive strategies are still lacking.

The Effect of SGLT2 Inhibitors on the Development of Contrast-Induced Nephropathy in Diabetic Patients with Non-ST Segment Elevation Myocardial Infarction

“…The most important finding obtained as a result of this study: The risk of nephropathy due to the use of contrast media after CAG and/or PCI procedures in diabetic patients with SGLT2 inhibitor in the treatment regimen was found to be significantly lower than in the patient group who did not use SGLT2 inhibitors. This is one of the pioneering studies in the literature showing that SGLT2 inhibitors may have a potential benefit in reducing or preventing the development of CIN and is, to our knowledge, the first study with an isolated NST-ACS patient population [ 20 , 21 , 22 ].…”

Incretins-Based Therapies and Their Cardiovascular Effects: New Game-Changers for the Management of Patients with Diabetes and Cardiovascular Disease

“…It is responsible for inhibiting sodium–hydrogen exchanger 3 (NHE3), an antiporter located on the epithelial cells of the proximal tube that imports sodium ions, simultaneously ejecting hydrogen ions in the proximal tubule lumen. NHE3 inhibition increases natriuresis and diuresis [ 32 , 33 , 34 ].…”

Effects of Finerenone on Cardiovascular and Chronic Kidney Diseases: A New Weapon against Cardiorenal Morbidity and Mortality—A Comprehensive Review

“…This study is designed to evaluate the cumulative efficacy, safety, and tolerability of dual therapy, including finerenone and empagliflozin in people with CKD and diabetes [ 79 ]. Considering the well-known protective effects of sodium–glucose transporter 2 inhibitors (SGLT2i) on the cardiovascular system [ 80 ] and renal functions [ 9 ], dual therapy with finerenone and SGLT2i could provide an additive effect in order to slow the disease progression and provide long-term benefits for patients with diabetes and CKD [ 79 ].…”

“…However, the optimal titration of this combination is often hampered by suboptimal creatinine levels, as only few studies included patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min [ 7 ]. Similarly, the use of sodium–glucose transporter 2 inhibitors (SGLT2i) for the treatment of heart failure also offers renal protection [ 8 , 9 ]. A recent study in patients with advanced CKD (eGFR 25–45 mL/min) showed that empagliflozin was associated with a reduced risk of renal progression or cardiovascular death compared to a placebo (hazard ratio, 0.72; 95% confidence interval [CI], 0.64–0.82; p < 0.001) [ 10 ].…”