接受经皮冠状动脉介入治疗的SGLT2抑制剂治疗患者的造影剂诱导急性肾损伤：一项倾向匹配分析
Contrast-Induced Acute Kidney Injury in Patients on SGLT2 Inhibitors Undergoing Percutaneous Coronary Interventions: A Propensity-Matched Analysis.
作者信息
Hua Rui, Ding Ning, Guo Hanqing, Wu Yue, Yuan Zuyi, Li Ting
机构信息
Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Gastroenterology, Xi'an Central Hospital, Xi'an, China.
出版信息
Front Cardiovasc Med. 2022 Jun 20;9:918167. doi: 10.3389/fcvm.2022.918167. eCollection 2022.
BACKGROUND
Contrast-induced acute kidney injury (CI-AKI) is a common complication of patients undergoing percutaneous coronary intervention (PCI). Data regarding the influence of sodium-glucose cotransporter-2 (SGLT2) inhibitor on the CI-AKI incidence and renal outcomes of patients undergoing PCI are limited. This study aimed to examine the real-world risk of CI-AKI in SGLT2 inhibitor users undergoing PCI.
METHODS
We used longitudinal data from the medical records of the First Affiliated Hospital of Xi'an Jiaotong University. We selected SGLT inhibitor users and nonusers [patients with type 2 diabetes (T2D) without SGLT2 inhibitor prescription] undergoing PCI. We determined CI-AKI by the ESUR (European Society of Urogenital Radiology, AKI) and KDIGO definition (Kidney Disease: Improving Global Outcomes, AKI). We performed 1:1 nearest-neighbor propensity matching and calculated unadjusted odds ratios (ORs) and adjusted ORs (aORs; accounting for covariates poorly balanced) for AKI in primary and sensitivity analyses. We compared the renal function indicators in users and nonusers at 24, 48, and 72 h post-PCI.
RESULTS
We identified 242 SGLT2 inhibitor users and 242 nonusers in the cohort. The unadjusted ORs of CI-AKI were 63% lower in users [OR: 0.37 (95% CI: 0.18-0.68); = 0.01], which was unchanged [aOR: 0.37 (95% CI: 0.19-0.67); < 0.01] post adjustment. These estimates did not qualitatively change across several sensitivity analyses. There was no significant difference in urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR) values between the two groups before PCI, and at 24 h, while the creatinine (48 and 72 h post-PCI) and CyC (24 and 48 h post-PCI) were significantly lower than those in the nonuser group ( < 0.05).
CONCLUSION
Our findings do not suggest an increased risk of CI-AKI associated with SGLT2 inhibitor use in patients with CAD and T2D undergoing PCI.
背景
对比剂诱导的急性肾损伤（CI-AKI）是接受经皮冠状动脉介入治疗（PCI）患者的常见并发症。关于钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对接受PCI患者的CI-AKI发生率和肾脏结局影响的数据有限。本研究旨在探讨接受PCI的SGLT2抑制剂使用者发生CI-AKI的实际风险。
方法
我们使用了西安交通大学第一附属医院病历中的纵向数据。我们选择了接受PCI的SGLT抑制剂使用者和非使用者[未开具SGLT2抑制剂处方的2型糖尿病（T2D）患者]。我们根据欧洲泌尿生殖放射学会（ESUR，AKI）和改善全球肾脏病预后组织（KDIGO，AKI）的定义来确定CI-AKI。我们进行了1:1最近邻倾向匹配，并在主要分析和敏感性分析中计算了AKI的未调整比值比（OR）和调整后比值比（aOR；考虑协变量平衡不佳）。我们比较了PCI术后24、48和72小时使用者和非使用者的肾功能指标。
结果
我们在队列中确定了242名SGLT2抑制剂使用者和242名非使用者。使用者中CI-AKI的未调整OR降低了63%[OR：0.37（95%CI：0.18-0.68）；P = 0.01]，调整后无变化[aOR：0.37（95%CI：0.19-0.67）；P < 0.01]。在几项敏感性分析中，这些估计值没有定性变化。两组在PCI术前和术后24小时的尿素氮、肌酐和估计肾小球滤过率（eGFR）值没有显著差异，而肌酐（PCI术后48和72小时）和胱抑素C（PCI术后24和48小时）显著低于非使用者组（P < 0.05）。
结论
我们的研究结果并不表明在患有CAD和T2D且接受PCI的患者中，使用SGLT2抑制剂会增加CI-AKI的风险。
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