Short-Term Peri-Procedural Dapagliflozin for Prevention of Contrast-Induced Acute Kidney Injury in Diabetic Patients Undergoing Coronary Computed Tomographic Angiography: A Prospective Randomized Double-Blind Placebo-Controlled Study.

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have established long-term cardiorenal benefits in patients with type 2 diabetes mellitus. However, their short-term peri-procedural role in preventing contrast-induced acute kidney injury (CI-AKI) after coronary computed tomographic angiography (CCTA) remains uncertain, and their acute effects on renal oxygenation may be complex. METHODS: This prospective, randomized, double-blind, placebo-controlled single-center study screened 352 diabetic patients scheduled for CCTA. A total of 335 patients were randomized, and 322 patients with complete baseline and post-CCTA creatinine assessment were included in the modified intention-to-treat analysis. Participants received dapagliflozin 10 mg once daily or matched placebo beginning 3 days before CCTA and continuing through the 72-hour post-CCTA follow-up. CI-AKI was defined according to prespecified serum creatinine-based criteria within 72 hours after contrast exposure. Serial renal indices and exploratory biomarker variables were summarized at available time points, and logistic regression was restricted to a parsimonious covariate set because of the limited number of events. RESULTS: The modified intention-to-treat analysis included 322 patients, with 161 patients assigned to each group. CI-AKI occurred in 29 patients overall (9.0%), with a significantly lower incidence in the dapagliflozin group than in the placebo group (6/161 [3.7%] vs. 23/161 [14.3%]; odds ratio, 0.23; 95% confidence interval, 0.09-0.59; P = 0.001 by Fisher exact test). Baseline renal indices, including serum creatinine, estimated glomerular filtration rate, blood urea nitrogen, neutrophil gelatinase-associated lipocalin, and baseline eGFR category distribution, were comparable between groups. At 72 hours after CCTA, the dapagliflozin group had lower serum creatinine and higher eGFR than the placebo group. KDIGO creatinine-based AKI stage distribution did not differ significantly between groups (P = 0.064), and no patient required new dialysis or kidney replacement therapy during the 72-hour follow-up. Exploratory secondary biomarker analyses showed lower blood urea nitrogen and neutrophil gelatinase-associated lipocalin levels at 72 hours in the dapagliflozin group. CONCLUSION: In diabetic patients undergoing CCTA, short-term peri-procedural dapagliflozin was associated with a lower incidence of creatinine-defined CI-AKI and improved early post-contrast renal function profiles. By focusing on a noninvasive CCTA population, this study expands the potential application of SGLT2 inhibition from invasive coronary procedures to intravenous contrast-enhanced cardiac CT, suggesting a novel adjunctive approach for renal risk reduction in selected diabetic patients. Larger multicenter trials are needed to validate these findings and define the patients most likely to benefit.