SGLT2 inhibitors and the risk of kidney injury during radiological examinations with iodinated contrast media

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Responds to queries received from Swedish healthcare and social service providers, or governmental organisations. Queries have a limited scope and the process is designed to enable a more rapid response, typically within two to three months. Reports are based on systematic reviews, that are identified through structured searches and critically appraised for risk of bias.

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Published: Report no: ut202604 Registration no: SBU 2025/1058

Question

What effect does treatment with SGLT-2 inhibitors have on the risk of contrast-induced nephropathy in individuals with risk factors such as advanced age (>64 years), type 2 diabetes, heart failure, or chronic kidney disease undergoing radiological procedures involving iodinated contrast media?

PICO

  • Population: Individuals with risk factors such as advanced age (>64 years), type 2 diabetes, heart failure, or chronic kidney disease who undergo radiographic examinations with iodinated contrast media.
  • Intervention: Regular or prophylactic treatment with SGLT2 inhibitors
  • Comparison: No treatment or treatment other than SGLT2 inhibitors
  • Outcome: Contrast-induced acute kidney injury or contrast‑induced impairment of renal function

Method

A systematic literature search was performed using the following databases: Medline (via Ovid), Scopus and Embase.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Nine relevant systematic reviews were identified. In all of the relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported[1-9].

References

  1. Ansari HUH, Samad MA, Mahboob E, Zulfiqar E, Qazi SU, Ahsan A, et al. Sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis. Am J Prev Cardiol. 2025;21:100927. Available from: https://doi.org/10.1016/j.ajpc.2024.100927
  2. Basutkar RS, Cutinha RM, Sathish V, Shahil A, Saneen CKN. Impact of SGLT2 Inhibitors on Renal Function in Type 2 Diabetic Patients with Coronary Artery Disease Undergoing Percutaneous Intervention: A Systematic Review and Meta-Analysis. Curr Diabetes Rev. 2025;21(9):e030724231535. Available from: https://doi.org/10.2174/0115733998301228240625065230
  3. Dimitriadis K, Vakka A, Pyrpyris N, Apostolos A, Beneki E, Stathopoulou E, et al. Efficacy of Chronic Use of Sodium-Glucose Co-transporter 2 Inhibitors on the Prevention of Contrast-Induced Acute Kidney Injury in Patients with Type 2 Diabetes Mellitus Following Coronary Procedures: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs. 2025;25(1):57-69. Available from: https://doi.org/10.1007/s40256-024-00684-y
  4. Fan G, Lin L, Zuo H, Yan R, Xu C. Sodium-glucose cotransporter 2 inhibitors and contrast-induced nephropathy risk: a meta-analysis. Eur J Clin Pharmacol. 2025;81(3):337-45. Available from: https://doi.org/10.1007/s00228-024-03799-y
  5. Xiaoyu L, Weifen W, Xiaohan X. Effect of SGLT2 Inhibitors on Post-PCI Outcomes after Acute Myocardial Infarction in Diabetic Patients: A Systematic Review and Meta-Analysis. The Heart Surgery Forum. 2024;27(4):E414-E23. Available from: https://doi.org/10.59958/hsf.7021
  6. Meregildo-Rodriguez ED, Asmat-Rubio MG, Vasquez-Tirado GA. SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14:1307715. Available from: https://doi.org/10.3389/fendo.2023.1307715
  7. Mirfendereski S, Ahmadnia M, Hasanpour Dehkordi A. Effect of sodium-glucose transporter 2 inhibitors on the risk of contrast-induced acute kidney injury; a systematic review and meta-analysis. J Renal Inj Prev. 2025;14(3). Available from: https://doi.org/10.34172/jrip.2025.38360
  8. Peng L, He Y, Zhang Z, Yin J, Fan J. Efficacy and safety of empagliflozin for the acute myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2025;57(1):2514078. Available from: https://doi.org/10.1080/07853890.2025.2514078
  9. Rafsanjani MRH, Rezvanfar K, Saghafi D, Sabbaghi S, Parastooei B, Darvishi M. The Effect of Sodium–Glucose Co-Transporter-2 Inhibitors in Contrast-Induced Acute Kidney Injury: A Systematic Review and Meta-Analysis. Int Tinnitus J. 2025;28:100-7. Available from: https://doi.org/10.5935/0946-5448.2024.S1.17

Search strategies

Medline via OvidSP 09 December 25

Title: SGLT-2 inhibitors and contrast-induced acute kidney injury
/ = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .kf = Keywords; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Intervention: SGLT-2 inhibitors
1. (SGLT-2 inhibitor* or gliflozin* or flozin* or Sodium-Glucose Transporter 2 Inhibitor* or Sodium-Glucose Transporter-2 Inhibitor* or Sodium-Glucose coTransporter-2 Inhibitor* or sglt2i or sglt2-i or SGLT2 or SGLT-2 or dapagliflozin or empagliflozin or canagliflozin).ti,ab,kf. 18 346
2. Exp Sodium-Glucose Transporter 2 Inhibitors/ 9290
3. 1 OR 2 19 046
Outcome: contrast-induced acute kidney injury
4. (contrast-induced nephropathy or CIN or acute kidney injury or AKI or contrast-induced acute kidney injury or CI-AKI or contrast induced nephropath* or Kidney Injur* or contrast-associated kidney injur* or nephropath*).ti,ab,kf. 147 031
5. Exp Acute Kidney Injury/ 62 512
6. 4 OR 5 179 252
Study types: systematic reviews and meta-analysis*
7. (Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or (((systematic or realist or integrative or mixed method* or umbrella or scoping) adj4 (review)) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/) 620 811
Combined sets:
8. 3 AND 6 AND 7 141
Final result
9.   141

* Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.

Scopus via scopus.com 09 December 25

Title: SGLT-2 inhibitors and contrast-induced acute kidney injury
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); W/n = Within. Proximity operator retrieving terms within n words from each other; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Intervention: SGLT-2 inhibitors
1. TITLE-ABS-KEY (“SGLT-2 inhibitor*” OR “gliflozin*” OR “flozin*” OR “gliflozin derivative” OR "Sodium-Glucose Transporter 2 Inhibitor*" OR “Sodium-Glucose Transporter-2 Inhibitor*” OR “Sodium-Glucose coTransporter-2 Inhibitor*” OR “sodium dependent glucose cotransporter 2 inhibitor” OR “sglt2i” OR “sglt2-i” OR “SGLT2” OR “SGLT-2” OR “dapagliflozin” OR “empagliflozin” or “canagliflozin”) 34 776
Outcome: Title: SGLT-2 inhibitors and contrast
2. TITLE-ABS-KEY (“contrast-induced nephropath*” OR CIN OR “acute kidney injur*” OR “AKI” OR “contrast-induced acute kidney injury” OR “CI-AKI” OR “contrast induced nephropath*” OR “Kidney Injur*” OR “contrast-associated kidney injur*” OR nephropath*) 241 751
Study types: systematic reviews and meta-analysis
3. TITLE-ABS-KEY ( ( (systematic OR realist OR integrative OR “mixed method*” or umbrella OR scoping) W/3 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 910 738
Combined sets:
4. 1 AND 2 AND 3 387
Final result
5.   387

Embase via Elsevier 12 December 25

Title: SGLT-2 inhibitors and contrast-induced acute kidney injury
/exp = Term from the EMTREE controlled vocabulary, including all narrower terms in the hierarchy; ti = Title; ab = Abstract; kw = Author keywords; it = Publication type; NEAR/n = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; ‘ ‘ = Citation Marks; searches for an exact phrase
Search terms Items found
Intervention: SGLT-2 inhibitors
1. 'sodium glucose cotransporter 2 inhibitor'/exp AND [embase]/lim 40 697
2. ('sglt-2 inhibitor*':ti,ab,kw OR 'sglt2 inhibitor*':ti,ab,kw OR 'sodium dependent glucose cotransporter 2 inhibitor':ti,ab,kw OR 'sodium glucose co-transporter 2 inhibitor*':ti,ab,kw OR 'sodium-glucose transporter 2 inhibitor*':ti,ab,kw OR 'sodium glucose cotransporter 2 inhibitor*':ti,ab,kw OR 'gliflozin derivative':ti,ab,kw OR 'gliflozin*':ti,ab,kw OR 'flozin*':ti,ab,kw) AND [embase]/lim 22 042
3. 4 OR 5 42 039
Outcome: contrast-induced acute kidney injury
4. 'acute kidney failure'/exp 159 419
5. ('acute kidney injury':ti,ab,kw OR 'acute kidney insufficiency':ti,ab,kw OR 'acute renal failure':ti,ab,kw OR 'acute renal insufficiency':ti,ab,kw OR 'kidney acute failure':ti,ab,kw OR 'kidney failure, acute':ti,ab,kw OR 'kidney insufficiency, acute':ti,ab,kw OR 'renal insufficiency, acute':ti,ab,kw OR 'acute kidney failure':ti,ab,kw) AND [embase]/lim 114 002
6. ('contrast-induced nephropath*':ti,ab,kw OR 'cin':ti,ab,kw OR 'acute kidney injur*':ti,ab,kw OR 'aki':ti,ab,kw OR 'contrast-induced acute kidney injur*':ti,ab,kw OR 'ci-aki':ti,ab,kw OR 'contrast induced nephropath*':ti,ab,kw OR 'kidney injur*':ti,ab,kw OR 'contrast-associated kidney injur*':ti,ab,kw OR 'nephropath*':ti,ab,kw) AND [embase]/lim 211 947
7. 7 OR 8 OR 9 307 113
Study types: systematic reviews and meta-analysis
8. ('systematic review'/de OR 'meta analysis'/de OR [cochrane review]/lim OR (((systematic NEAR/4 review) OR 'meta analys*' OR metaanalys*):ti,ab)) NOT ('case report'/de OR 'editorial'/it OR 'letter'/it OR 'note'/it) 846 363
Combined sets:
9. 3 AND 7 AND 8 325
Final result
10.   325

 

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