Supplementary Material for: The association between dapagliflozin use and the risk of post contrast acute kidney injury in patients with type 2 diabetes and chronic kidney disease: a propensity-matched analysis

Introduction This study aimed to investigate the effect of dapagliflozin in preventing post contrast acute kidney injury (PC-AKI) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD) who underwent an elective coronary procedure. Methods Data of patients with T2DM and CKD undergoing an elective coronary procedure at Civil Aviation General Hospital from October 2020 to April 2023, were collected from the electronic medical records. Based on dapagliflozin usage, patients were classified as dapagliflozin users and non-users. 1:1 nearest-neighbor propensity matching was performed to compare dapagliflozin users with non-users. The primary endpoint was the first PC-AKI observed. Univariate and multivariate COX regression models were used to determine the independent risk/preventive factors for PC-AKI. Thereafter, subgroup analyses were performed to evaluate the interaction between subgroup and dapagliflozin usage. Changes in the serum creatinine (SCr) and cystatin C (CysC) levels were monitored at 24h, 48h and 72h after the procedure. Results 256 pairs (256 dapagliflozin users in the dapagliflozin group and 256 dapagliflozin non-users in the control group) were identified in the cohort. The incidence of PC-AKI in dapagliflozin group (10.9%) was lower than that in control group (22.3%). COX regression analyses showed that dapagliflozin use was associated with a lower risk of PC-AKI (HR 0.81, 95% CI: 0.69-0.95, P=0.01) after adjustment for covariates. In the subgroup analyses, similar HRs of the dapagliflozin usage on the PC-AKI outcome were observed in patients across different patients’ characteristics which revealed its consistent benefit of preventing PC-AKI. The eGFR levels at post-48h and 72h were significant higher in the dapagliflozin group than those in the control group, while levels of SCr (post-48h and 72h) and CysC (post-24h and 48h) in the dapagliflozin group were lower compared with the control group. Conclusion Our findings suggest dapagliflozin effectively decrease PC-AKI risk and exert reno-protective effects in patients with T2DM and CKD undergoing an elective coronary procedure.

引言 本研究旨在探讨达格列净（dapagliflozin）对接受择期冠状动脉手术的2型糖尿病（T2DM）合并慢性肾脏病（CKD）患者预防造影剂急性肾损伤（PC-AKI）的作用。
方法 本研究收集了2020年10月至2023年4月于民航总医院接受择期冠状动脉手术的2型糖尿病合并慢性肾脏病患者的电子病历数据。根据是否使用达格列净，将患者分为达格列净使用者组与非使用者组。采用1:1倾向性评分最近邻匹配法对两组患者进行匹配，以比较达格列净使用者与非使用者的结局。本研究的主要终点为首次发生的造影剂急性肾损伤。采用单因素及多因素COX回归模型分析造影剂急性肾损伤的独立危险因素与保护因素。随后开展亚组分析，以评估亚组特征与达格列净使用之间的交互作用。分别于术后24h、48h及72h监测患者血清肌酐（SCr）与胱抑素C（CysC）水平的变化。
结果 本研究队列中共纳入256对匹配患者（达格列净组256例，对照组256例达格列净非使用者）。达格列净组造影剂急性肾损伤发生率为10.9%，低于对照组的22.3%。校正协变量后，COX回归分析显示，使用达格列净与造影剂急性肾损伤的发病风险降低相关（风险比HR=0.81，95%置信区间CI：0.69~0.95，P=0.01）。亚组分析结果显示，在不同基线特征的患者中，达格列净使用对造影剂急性肾损伤结局的风险比均相似，提示其预防造影剂急性肾损伤的获益具有一致性。术后48h及72h，达格列净组的估算肾小球滤过率（eGFR）水平显著高于对照组；而达格列净组术后48h、72h的血清肌酐水平，以及术后24h、48h的胱抑素C水平均低于对照组。
结论 本研究结果表明，对于接受择期冠状动脉手术的2型糖尿病合并慢性肾脏病患者，达格列净可有效降低造影剂急性肾损伤的发病风险，并发挥肾脏保护作用。