Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)
Abstract 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 r...
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BMC
2025-05-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-025-02773-x |
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| author | Pasquale Paolisso Marta Belmonte Emanuele Gallinoro Roberto Scarsini Luca Bergamaschi Leonardo Portolan Matteo Armillotta Giuseppe Esposito Elisabetta Moscarella Claudio Montalto Elayne Kelen de Oliveira Francesco Angeli Mateusz Orzalkiewicz Margherita Fabroni Verdiana Galli Nurcan Baydaroglu Francesca Di Lenarda Pasquale Policastro Carlo Terrone Davide Ausiello Giose Vincelli Matteo Casenghi Lucia Scisciola Raffaele Marfella Felice Gragnano Edoardo Conte Dario Pellegrini Alfonso Ielasi Daniele Andreini Jacopo Andrea Oreglia Paolo Calabrò Antonio L. Bartorelli Tullio Palmerini Francesco Saia Flavio Ribichini Michelangela Barbieri Marc Vanderheyden Carmine Pizzi Emanuele Barbato |
| author_facet | Pasquale Paolisso Marta Belmonte Emanuele Gallinoro Roberto Scarsini Luca Bergamaschi Leonardo Portolan Matteo Armillotta Giuseppe Esposito Elisabetta Moscarella Claudio Montalto Elayne Kelen de Oliveira Francesco Angeli Mateusz Orzalkiewicz Margherita Fabroni Verdiana Galli Nurcan Baydaroglu Francesca Di Lenarda Pasquale Policastro Carlo Terrone Davide Ausiello Giose Vincelli Matteo Casenghi Lucia Scisciola Raffaele Marfella Felice Gragnano Edoardo Conte Dario Pellegrini Alfonso Ielasi Daniele Andreini Jacopo Andrea Oreglia Paolo Calabrò Antonio L. Bartorelli Tullio Palmerini Francesco Saia Flavio Ribichini Michelangela Barbieri Marc Vanderheyden Carmine Pizzi Emanuele Barbato |
| author_sort | Pasquale Paolisso |
| collection | DOAJ |
| description | Abstract 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. Graphical abstract Summary of the main findings of the study. |
| format | Article |
| id | doaj-art-8a6e6fe73b9c48f593ad657e46f63ad9 |
| institution | OA Journals |
| issn | 1475-2840 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj-art-8a6e6fe73b9c48f593ad657e46f63ad92025-08-20T02:34:16ZengBMCCardiovascular Diabetology1475-28402025-05-0124111110.1186/s12933-025-02773-xImpact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)Pasquale Paolisso0Marta Belmonte1Emanuele Gallinoro2Roberto Scarsini3Luca Bergamaschi4Leonardo Portolan5Matteo Armillotta6Giuseppe Esposito7Elisabetta Moscarella8Claudio Montalto9Elayne Kelen de Oliveira10Francesco Angeli11Mateusz Orzalkiewicz12Margherita Fabroni13Verdiana Galli14Nurcan Baydaroglu15Francesca Di Lenarda16Pasquale Policastro17Carlo Terrone18Davide Ausiello19Giose Vincelli20Matteo Casenghi21Lucia Scisciola22Raffaele Marfella23Felice Gragnano24Edoardo Conte25Dario Pellegrini26Alfonso Ielasi27Daniele Andreini28Jacopo Andrea Oreglia29Paolo Calabrò30Antonio L. Bartorelli31Tullio Palmerini32Francesco Saia33Flavio Ribichini34Michelangela Barbieri35Marc Vanderheyden36Carmine Pizzi37Emanuele Barbato38Cardiology Unit, Sant’Andrea University HospitalCardiology Unit, Sant’Andrea University HospitalCardiology Unit, Sant’Andrea University HospitalCardiovascular Department, Azienda Ospedaliero Universitaria IntegrataUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSCardiovascular Department, Azienda Ospedaliero Universitaria IntegrataUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSInterventional Cardiology, De Gasperis Cardio Center, Niguarda HospitalDivision of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”Interventional Cardiology, De Gasperis Cardio Center, Niguarda HospitalDept. of Advanced Biomedical Sciences, University Federico IIUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSCardiovascular Department, Azienda Ospedaliero Universitaria IntegrataCardiovascular Department, Azienda Ospedaliero Universitaria IntegrataInterventional Cardiology, De Gasperis Cardio Center, Niguarda HospitalUniversity Cardiology, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiology Unit, Sant’Andrea University HospitalCardiology Unit, Sant’Andrea University HospitalCardiology Unit, Sant’Andrea University HospitalCardiology Unit, Sant’Andrea University HospitalCardiology Unit, Sant’Andrea University HospitalDepartment of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”University Cardiology, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiology Division, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiology Division, IRCCS Galeazzi-Sant’Ambrogio HospitalUniversity Cardiology, IRCCS Galeazzi-Sant’Ambrogio HospitalInterventional Cardiology, De Gasperis Cardio Center, Niguarda HospitalDivision of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”University Cardiology, IRCCS Galeazzi-Sant’Ambrogio HospitalUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSCardiovascular Department, Azienda Ospedaliero Universitaria IntegrataDepartment of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”Cardiovascular Center Aalst, OLV-ClinicUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Sant’Orsola-Malpighi Hospital, IRCCSCardiology Unit, Sant’Andrea University HospitalAbstract 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. Graphical abstract Summary of the main findings of the study.https://doi.org/10.1186/s12933-025-02773-xSGLT2iTranscatheter aortic valve implantation (TAVI)Acute kidney injuryChronic kidney diseaseAortic stenosis |
| spellingShingle | Pasquale Paolisso Marta Belmonte Emanuele Gallinoro Roberto Scarsini Luca Bergamaschi Leonardo Portolan Matteo Armillotta Giuseppe Esposito Elisabetta Moscarella Claudio Montalto Elayne Kelen de Oliveira Francesco Angeli Mateusz Orzalkiewicz Margherita Fabroni Verdiana Galli Nurcan Baydaroglu Francesca Di Lenarda Pasquale Policastro Carlo Terrone Davide Ausiello Giose Vincelli Matteo Casenghi Lucia Scisciola Raffaele Marfella Felice Gragnano Edoardo Conte Dario Pellegrini Alfonso Ielasi Daniele Andreini Jacopo Andrea Oreglia Paolo Calabrò Antonio L. Bartorelli Tullio Palmerini Francesco Saia Flavio Ribichini Michelangela Barbieri Marc Vanderheyden Carmine Pizzi Emanuele Barbato Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) Cardiovascular Diabetology SGLT2i Transcatheter aortic valve implantation (TAVI) Acute kidney injury Chronic kidney disease Aortic stenosis |
| title | Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) |
| title_full | Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) |
| title_fullStr | Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) |
| title_full_unstemmed | Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) |
| title_short | Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) |
| title_sort | impact of sglt2 inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation tavi |
| topic | SGLT2i Transcatheter aortic valve implantation (TAVI) Acute kidney injury Chronic kidney disease Aortic stenosis |
| url | https://doi.org/10.1186/s12933-025-02773-x |
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