Effect of dapagliflozin on acute renal injury in patients with coronary heart disease and diabetes mellitus after percutaneous coronary intervention

He Minghao; Yang Yiping; Fu Shenwen

doi:10.3969/j.issn.1672-8157.2025.04.038

Abstract：Objective To investigate the effect of dapagliflozin on acute kidney injury(AKI)in patients with coronary heart disease(CHD)and diabetes mellitus(DM)after percutaneous coronary intervention(PCI).Methods A total of 141 cases with CHD and DM who underwent PCI in Jinhua Municipal Central Hospital from May 2022 to March 2024 were randomly divided into two groups according to the random number table method.The control group(n=71)received the conventional treatment regimen,including aspirin,clopidogrel,metformin and statins,started medication 6 days before PCI treatment.The observation group(n=70)was treated with dapagliflozin in addition,with continuous administration starting at least 4 weeks before PCI and continuing until 7 days postoperatively.All patients'clinical data were collected,and the clinical basic data,renal function indexes(serum creatinine(Scr)and estimate glomerular filtration rate(eGFR))within 24 h after surgery,as well as serious adverse events during treatment pe-riod and the occurrence of AKI from 48 h to 7 days after surgery were compared.Patients who developed AKI were included in the AKI group,and those who did not develop AKI were included in the non-AKI group.Univariate analysis(independent sample t-test,χ2 test)and multivariate Logistic regression analysis were used to analyze the influencing factors of AKI in patients with CHD and DM after PCI treatment.Results After treatment,the Scr level of the patients in the observation group((85.43±17.09)μmol·L-1)was lower than that of the control group((92.37±18.47)μmol·L-1),and the eGFR level((89.67±20.41)mL·min-1·1.73m-2)was higher than that of the control group((82.19±19.96)mL·min-1·1.73m-2),and the differences were statistically significant(t=2.315,2.200,P=0.022,0.029).Both groups of patients did not experience any serious adverse events during the treatment period.In terms of the overall incidence of postoperative AKI,the control group was 14.08% (10/71)and the observation group was 4.29% (3/70),with a statis-tically significant difference between the two groups(χ2=4.044,P=0.044).The results of univariate analysis showed that the left ventric-ular ejection fraction(LVEF)level in the AKI group was lower than that in the non-AKI group((51.23±4.08)%,(56.97±7.12)% ),and the proportion of patients with a history of anemia and the proportion of those receiving conventional treatment regimens was higher than that in the non-AKI group(30.77% (4/13)vs 7.81% (10/128),76.92% (10/13)vs 47.66% (61/128))(t=2.853,χ2=4.624,4.044,P=0.005,0.032,0.044).Multivariate analysis showed that LVEF(OR=0.478,95% CI:0.251±0.910),whether dapagliflozin was used(OR=0.227,95% CI:0.071±0.721),and serum IL-18 24 hours after surgery(OR=2.527,95% CI:1.308±4.882)were the influencing factors of AKI in patients with CHD and DM after PCI(P=0.025,0.012,0.006).Conclusion Dapagliflozin has a protective effect on AKI in patients with CHD and DM after PCI,and can reduce the risk of AKI.