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

INTRODUCTION: 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-h post-CCTA follow-up. CI-AKI was defined according to prespecified serum creatinine-based criteria within 72 h 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's 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 h 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-h follow-up. Exploratory secondary biomarker analyses showed lower blood urea nitrogen and neutrophil gelatinase-associated lipocalin levels at 72 h 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.