钠-葡萄糖协同转运蛋白2抑制剂对接受经导管主动脉瓣植入术（TAVI）的重度主动脉瓣狭窄糖尿病患者急性肾损伤的影响。
Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).
作者信息
Paolisso Pasquale, Belmonte Marta, Gallinoro Emanuele, Scarsini Roberto, Bergamaschi Luca, Portolan Leonardo, Armillotta Matteo, Esposito Giuseppe, Moscarella Elisabetta, Montalto Claudio, de Oliveira Elayne Kelen, Angeli Francesco, Orzalkiewicz Mateusz, Fabroni Margherita, Galli Verdiana, Baydaroglu Nurcan, Di Lenarda Francesca, Policastro Pasquale, Terrone Carlo, Ausiello Davide, Vincelli Giose, Casenghi Matteo, Scisciola Lucia, Marfella Raffaele, Gragnano Felice, Conte Edoardo, Pellegrini Dario, Ielasi Alfonso, Andreini Daniele, Oreglia Jacopo Andrea, Calabrò Paolo, Bartorelli Antonio L, Palmerini Tullio, Saia Francesco, Ribichini Flavio, Barbieri Michelangela, Vanderheyden Marc, Pizzi Carmine, Barbato Emanuele
机构信息
Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy.
Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
出版信息
Cardiovasc Diabetol. 2025 May 21;24(1):221. doi: 10.1186/s12933-025-02773-x.
BACKGROUND
Acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI) is associated with significantly worse outcomes, leading to increased short- and long-term mortality. We sought to evaluate the impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the risk of AKI in patients with type 2 diabetes mellitus (T2DM) and severe aortic stenosis (AS) undergoing TAVI.
METHODS
Multicenter international registry of consecutive T2DM patients with severe AS undergoing TAVI between 2021 and 2024. The study population was stratified by the presence of chronic kidney disease (CKD), defined according to the KDIGO guideline, and anti-diabetic therapy at hospital admission (SGLT2i versus no-SGLT2i users). AKI was defined according to the Valve Academy Research Consortium 3 (VARC-3) criteria.
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 on SGLT2i treatment. The median age was 81 [77-84] years, and 60.1% were males. SGLT2i use did not impact renal function in patients without CKD, with AKI occurring in 7.1% of the cases, regardless of SGLT2i use. Among CKD patients, AKI occurred more frequently in no-SGLT2i users compared to those receiving SGLT2i (19.8% versus 8.5%, p = 0.027), with a significant increase in post-TAVI and discharge serum creatinine values for no-SGLT2i users (p = 0.001 after TAVI and p < 0.001 at hospital discharge). Only in the CKD group, the use of SGLT2i was identified as an independent predictor of a lower rate of AKI (OR 0.70, 95%CI 0.42-0.91, p = 0.014). Patients who developed AKI had a higher incidence of major adverse cardiovascular events during follow-up, regardless of CKD (p < 0.025 for both groups).
CONCLUSION
In diabetic patients with CKD undergoing TAVI, SGLT2i therapy was associated with a lower occurrence of AKI compared to those not treated with SGLT2i, suggesting a potential nephroprotective effect in this high-risk population.
背景
经导管主动脉瓣植入术（TAVI）后发生的急性肾损伤（AKI）与显著更差的预后相关，导致短期和长期死亡率增加。我们旨在评估钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对接受TAVI的2型糖尿病（T2DM）和严重主动脉瓣狭窄（AS）患者发生AKI风险的影响。
方法
对2021年至2024年间连续接受TAVI的重度AS的T2DM患者进行多中心国际注册研究。根据KDIGO指南定义的慢性肾脏病（CKD）的存在情况以及入院时的抗糖尿病治疗（SGLT2i使用者与非SGLT2i使用者）对研究人群进行分层。根据瓣膜学术研究联盟3（VARC-3）标准定义AKI。
结果
研究人群包括514例患者，分为无CKD组（n = 226，44%），其中43例（19%）接受SGLT2i治疗，以及CKD组288例（56%），其中71例（24.7%）接受SGLT2i治疗。中位年龄为81[77 - 84]岁，男性占60.1%。在无CKD的患者中，使用SGLT2i对肾功能无影响，无论是否使用SGLT2i，AKI发生率均为7.1%。在CKD患者中，未使用SGLT2i的患者AKI发生率高于接受SGLT2i治疗的患者（19.8%对8.5%，p = 0.027），未使用SGLT2i的患者TAVI后和出院时血清肌酐值显著升高（TAVI后p = 0.001，出院时p < 0.001）。仅在CKD组中，使用SGLT2i被确定为AKI发生率较低的独立预测因素（OR 0.70，95%CI 0.42 - 0.91，p = 0.014）。发生AKI的患者在随访期间主要不良心血管事件的发生率更高，无论是否有CKD（两组p均< 0.025）。
结论
在接受TAVI的CKD糖尿病患者中，与未接受SGLT2i治疗的患者相比，SGLT2i治疗与较低的AKI发生率相关，提示在这一高危人群中具有潜在的肾脏保护作用。
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