The Effect of short-term SGLT2 Inhibitors therapy on the Development of Contrast-induced acute kidney injury in Diabetic Patients undergoing Coronary computed tomographic angiography：a prospective study

The Effect of short-term SGLT2 Inhibitors therapy on the Development of Contrast-induced acute kidney injury in Diabetic Patients undergoing Coronary computed tomographic angiography：a prospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of short-term SGLT2 Inhibitors therapy on the Development of Contrast-induced acute kidney injury in Diabetic Patients undergoing Coronary computed tomographic angiography：a prospective study Tian zheng, LiFeng Zhang, YuXuan Zhong, Xiaoshu Cheng, Jianxin Hu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7694999/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Notably, SGLT2 inhibitors are renowned for their renal protective properties. However, empirical evidence regarding their efficacy in mitigating CI-AKI risk during Coronary computed tomographic angiography(CCTA) in diabetic cohorts remains scarce. Methods : This research conducted a double blind randomized clinical trial involving 352 patients undergoing CCTA. Participants were randomly assigned to receive SGLT2i (treatment group) or a placebo（control group）, starting 3 days before CCTA. The patients’ serum creatinine levels were evaluated at before and after the procedure. Univariate and multivariate logistic regression analyses were performed to assess the associations of demographic, clinical, and procedural characteristics with CI-AKI. Results: Finally, 161 patients entered each group, two groups patients had no significant demographic and clinical data differences before CCTA. We showed that the incidence of CI- AKI was meaningfully lower in the treatment group (5.15%) than in the control group (13.88%, P = 0.024).Univariate and multivariate regression analysis showed that SGLT2i significantly lowered the rate of CI-AKI [odds ratio(OR)=0.242], increasing Age (OR=1.070), high BNP level (OR=1.001), and high homocysteine values (OR=1.053) were positively correlated with CI- AKI (all p<0.05). Conclusion : Observations obtained from this investigation indicate that the use of SGLT2 inhibitors could be protective against the occurrence of CI-AKI in diabetic patients undergoing CCTA. SGLT2 Inhibitors Contrast induced acute kidney injury Diabetic Patients Coronary computed tomographic angiography homocysteine Figures Figure 1 1. Introduction Coronary computed tomographic angiography(CCTA) is largely used as the first line of diagnostic approach in patients with low pretest probability for coronary heart disease [ 1 ] . CCTA continues to evolve with the integration of deep learning and AI technology, broadening its applicability in the standardized CT protocol for transcatheter aortic valve replacement (TAVR) planning and the identification of other vulnerable plaques in myocardial infarction patients [ 2 ] . A relevant issue that has recently garnered attention is contrast-induced acute kidney injury (CI-AKI), which has been reported to occur frequently with the use of contrast media in CCTA [ 3 ] . CI-AKI is considered a new-onset or exacerbation of renal dysfunction following the administration of contrast media, without other potential causes. [ 4 ] . This condition ranks as the third most frequent cause of acute kidney injury acquired within hospital settings [ 5 ] . In 2023, Wang et al. conducted a comprehensive bibliometric analysis of the current state of research in the field of CI-AKI. They included 4,775 CI-AKI-related articles, and recent focus has been placed on risk factors for CI-AKI, prevention and treatment strategies, evaluation of the effects of contrast media and potential mechanisms of injury [ 6 ] . Nevertheless, the specific incidence and associated risks of CI- AKI among diabetic patients receiving CCTA have yet to be determined. Sodium/glucose co-transporter 2 (SGLT2) inhibitors, originally designed for the management of type 2 diabetes, have been shown to significantly lower the rates of heart failure admissions, cardiovascular mortality among individuals with or without diabetes, thereby extending their clinical benefits to robust cardio-renal outcomes [ 7 ] . Among patients with heart failure with mildly reduced ejection fraction (HFmrEF) or Heart failure with preserved ejection fraction(HFpEF) treated with dapagliflozin, an initial decline in eGFR and a reduction in urinary albumin are commonly observed [ 8 ] . Emerging research indicates that SGLT2 inhibitors might diminish the likelihood of CI- AKI in diabetic patients undergoing coronary angiography (CAG)or percutaneous coronary intervention(PCI) [ 9 ] ,and Paolisso et al found the use of SGLT2-I was associated with a lower risk of CI-AKI in diabetic patients with acute myocardial infarction, and the protective effects appear more prominent in patients without chronic kidney disease [ 10 ] . Although recent progress has been observed, there is still a significant lack of information about the impact of SGLT2 inhibitors on the prevalence of CI-AKI among CCTA patients. Consequently, our study is aimed at evaluating how SGLT2 inhibitors might influence the occurrence of CI-AKI in the diabetes population. 2. Materials and methods Ethics statement Our clinical research is registered in the Chi CTR,NO.2500098100. This study was approved by the Institutional Review Board (IRB) of Nanchang University's Second Affiliated Hospital, approval number code N-202007038. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individuals before they enrolled in the study. Characteristics of the study population This prospective study was conducted at a single healthcare facility, examining 352 patients diagnosed with Type 2 DM, were subjected to CCTA between January 1, 2024, and January 1, 2025. Of the patients in experimental group, patients were given dapagliflozin SGLT2 inhibitor, at a dose of 10 mg once a day. This treatment was initiated at 3 days prior to their CCTA. The other patients who form the control group were taken a placebo table, was similar in terms of color, shape, and packaging to dapagliflozin . After excluding patients with missing data and those who could not complete follow-up, a total of 312 participants were analyzed (Fig. 1).The duration of medication use prior to CCTA was verified using electronic health records. The primary outcome of our study was to compare the incidence of CI-AKI between two groups. Inclusion and exclusion criteria Study participants were included patients who were clinically diagnosed with T2DM and underwent CCTA ,experiencing angina and chest pain. The criteria for inclusion required that candidates be adults aged 18 or older with stable vital signs, a clear understanding of the study's procedures, and a demonstrated ability to comply with study requirements. Exclusion criteria included individuals diagnosed with suffering from severe heart failure, as classified by the New York Heart Association at a level III or higher; end-stage kidney disease;Already on SGLT2 inhibitors; kidney replacement therapy, missing data and those with a known allergy to contrast agents. Randomization and blinding Stratified block randomization was used to allocate eligible subjects. Closed envelopes marked with A or B labels were employed for the placebo and intervention groups, respectively. The envelopes were opened sequentially in the presence of each participant. The allocation list, maintained by the faculty of Medicine, was secure, and researchers were denied access until the conclusion of the study. This method effectively ensured that both patients and investigators were blinded to treatment allocation, preserving the integrity of the blinding process. Based on previous studies, the estimated incidence rates in the exposed and unexposed groups are set as p1and p2, respectively. The effect size is defined as ES = |p1- p2|.A two - sided significance level of α = 0.05 is set, corresponding to a 95% confidence level. the sample size formula is:N=( p 1​− p 2​)2( Z 1 − α /2​2 p ˉ​(1 − p ˉ​)​+ Z 1 − β ​ p 1​(1 − p 1​) + p 2​(1 − p 2​)​)2​ Considering the calculation results and practical feasibility, a total of 322 participants (161 in each of the exposed and unexposed groups) will be enrolled in this study to ensure sufficient statistical power. Acquisition and analyses of coronary CTA Coronary artery calcification was assessed in all participants. The scan settings included a tube voltage ranging from 100–120 kV, a tube current between 100–300 mAs, and a collimator set at 128×0.625 mm. The X-ray tube rotated at a speed of 0.27 seconds per revolution, with a resolution matrix of 512×512. For contrast enhancement, a non-ionic contrast medium, iophorol (370mg/mL, produced by Jiangsu Hengrui in Lianyungang, China), was administered at a rate of 4–5 mL/s, followed by an equivalent flow of 50 mL saline. An artificial intelligence system initiated the delay timing, targeting the ascending aorta at the primary pulmonary window as the area for dynamic monitoring. The scanning process automatically commenced once the CT value reached 150 HU, after a 6-second pause [ 11 ] . Risk factors and laboratory analyses Initial assessments employed standardized surveys to gather information on patient demographics, use of medications, and their smoking and alcohol consumption habits. The diagnostic criteria for hypertension in this study included any patient with a SBP of 140 mm Hg or above, a DBP of 90 mm Hg or more, or those undergoing treatment with antihypertensive medications. Hyperlipidemia was defined as TC ≥ 6.22 mmol/L, TG ≥ 2.26 mmol/L, and LDL-C ≥ 4.14 mmol/L, or patients were prescribed lipid-lowering drugs. Throughout hospitalization, each patient underwent a detailed transthoracic echocardiography using the advanced Vivid 5 system by GE Vingmed Ultrasound AS, based in Horten, Norway. This echocardiography employed the biplane Simpson method to accurately measure the LVEF. Moreover, laboratory evaluations comprising blood counts, homocysteine levels, lipid profiles, renal function, and glucose tests were conducted before and 48 hours,72 hours after the CCTA. Definition of Outcome The primary outcome was the occurrence of the first Acute Kidney Injury (AKI) event during hospitalization. We identified Contrast-Induced Acute Kidney Injury (CI-AKI) events using a laboratory-based algorithm that adheres to the European Society of Urogenital Radiology (ESUR) serum creatinine criteria. (This criteria defines CI-AKI events as an increase in serum creatinine by ≥ 44.2 µmol/L or 0.5 mg/dL within 72 hours, or an increase in serum creatinine by ≥ 1.25 times the baseline value (hereafter referred to as CI-AKI-ESUR). The last laboratory values obtained before the patient underwent Coronary Angiography (CAG) served as the baseline data for analysis, ensuring the most accurate reflection of each patient's baseline renal function. The renal function parameters, including serum creatinine and urea nitrogen, NGAL were collected upon admission and measured at 24, 48, and 72 hours post-CAG using the VITROS5600 automatic biochemical immune analyzer (JNJ, New Jersey, US). The estimated Glomerular Filtration Rate (eGFR, in ml/min/1.73 m^2) was calculated using the Modification of Diet in Renal Disease (MDRD) equation: 186.3×(serum creatinine in mg/dL)^-1.154×(age in years)^-0.203×(0.742 for women)×(1.21 for blacks). Statistical analysis Analysis of the data was conducted utilizing SPSS software, release 26.0. Normality tests were utilized to determine the Gaussian distribution of the variables. Mean values and standard deviations described continuous variables, while categorical variables were expressed in percentages. Renal function outcomes were compared using the Student's t-test, and the chi-squared test was used to evaluate the quality of the images.Linear regression was performed to evaluate the relationship between the rate of CI-AKI and demographic, clinical, and procedural characteristics. Variables were selected for inclusion in a multivariable model based on their univariate associations (P < 0.05). Subsequently, variables that met predefined criteria for entry (P < 0.05) were incorporated into the final multivariable model, which was then assessed for goodness of fit using the R − squared value. To determine if the risks of CI-AKI varied among different subgroups, analyses were performed based on various factors. In the statistical analysis conducted, a p-value below 0.05 was deemed significant for the purpose of two-tailed tests. 3. Results A total of 352 diabetes participants underwent CCTA, of whom 322 participants successfully completed the study【Figure 1】. The median age was reported as 65.02 ± 10.89 years, with males comprising 65.8% (212 individuals). The occurrence rate of CI-AKI within the studied population stood at 11.20%. Notably, the prevalence of CI-AKI among individuals treated with SGLT2 inhibitors (treatment group, 5.15%) was markedly lower compared to those control group(13.88%), a difference that reached statistical significance (p = 0.024). Table 1 lists the rest of the demographic characteristics of the patients, clinical and laboratory parameters. The two groups had no significant demographic and clinical data differences. Table 1 Comparisons of baseline characteristics between the two groups. Characteristics Control group Treatment group P-value Male,n(%) 67.70% 63.97% 0.557 Age,years 64.11 ± 10.77 65.93 ± 10.96 0.133 History of CKD(%) 44.09% 52.79% 0.147 History of Hypertension,(%) 21.11% 20.49% 1.000 History of myocardial infarction,(%) 9.31% 14.90% 0.171 Smoker,(%) 21.74% 19.25% 0.679 Alcohol,(%) 50.93% 60.87% 0.092 Hemoglobin level,g/l 132.34 ± 19.76 131.81 ± 20.37 0.816 Total cholesterol, mmol/L 4.39 ± 1.52 4.22 ± 1.09 0.235 Triglyceride, mmol/L 1.78 ± 1.31 2.30 ± 5.51 0.249 HDL-C,mmol/L 1.11 ± 0.32 1.14 ± 0.36 0.052 LDL-C, mmol/L 2.36 ± 0.95 2.25 ± 0.76 0.237 Uric acid,µmol/l 383.45 ± 106.40 387.28 ± 112.27 0.754 Fasting glucose,mmol/l 8.15 ± 2.99 8.26 ± 2.71 0.211 HbA1c,% 7.30 ± 1.36 7.07 ± 1.03 0.861 Lipoprotein(a),mg/dL 163.07 ± 56.65 165.26 ± 46.12 0.455 Left ventricular ejection fraction, LVEF % 56.26 ± 10.42 52.18 ± 8.00 0.455 Homocysteine,umol/L 18.64 ± 11.20 17.24 ± 6.64 0.173 ALT,U/L 32.85 ± 20.15 29.17 ± 20.13 0.462 AST,U/L 44.69 ± 87.21 33.76 ± 45.35 0.159 Medications ACEi/ARB(%) 58.33% 55.59% 0.755 CCB (%) 39.75% 34.16% 0.356 Beta blocker (%) 30.55% 32.86% 0.278 Diuretics (%) 25.00% 20.27% 0.125 Metformin(%) 13.88% 11.53% 0.680 Acarbose(%) 9.68% 8.76% 0.899 Statins (%) 58.33% 73.07% 0.065 Aspirin (%) 44.44% 62.68% 0.103 Clopidogrel (%) 32.30% 32.92% 1.000 Ticagrelor (%) 18.60% 22.98% 0.410 ALT, Alanine Aminotransferase;AST, Aspartate Aminotransferase;ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; CCB, calcium channel blocker; CKD, chronic kidney disease; ApoAI, apolipoprotein A-I;eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin A1c; HDL-C, high-density lipoprotein; LDL-C,low-density lipoprotein; CI-AKI, contrast induced acute kidney injury; BNP, brain natriuretic peptide. Table 2 outlines the variations in Scr and eGFR measurements taken before and after CCTA. Initially, Scr(84.66 ± 53.62 vs 82.32 ± 35.56 umol/L) and GFR (78.87 ± 8.67 vs 78.69 ± 22.19) readings showed no significant differences between the two groups prior to the CCTA. However, at 48 hours following the procedure, Scr values in the SGLT2i group(81.07 ± 39.22) were notably lower than those in the control group (130.96 ± 95.09, p = 0.001). At this specific time point, a notable decline in GFR levels was observed in the SGLT2i group when compared with the control group(61.03 ± 10.25 vs 51.02 ± 13.34 )at 72 hours post CCTA, demonstrating statistical significance (p < 0.001). It can also be observed that 72 hours later, the levels of blood urea nitrogen (BUN) and neutrophil gelatinase-associated lipocalin (NGAL) in the sodium-glucose cotransporter 2 inhibitor (SGLT2i) group were significantly lower than those in the conventional treatment group. Table 2 Comparisons of baseline characteristics between the two groups. Characteristics Control group Treatment group P-value Scr Baseline(µmol/L) 84.66 ± 53.62 82.32 ± 35.56 0.216 48h postprocedure Scr 130.96 ± 95.09 81.07 ± 39.22 < 0.001 72 hours postprocedure Scr 149.34 ± 43.52 93.31 ± 24.37 < 0.001 eGFR Baseline(mL/min) 78.87 ± 8.67 78.69 ± 22.19 0.985 48 hours postprocedure 65.79 ± 7.58 62.67 ± 13.19 0.628 72 hours postprocedure 51.02 ± 13.34 61.03 ± 10.25 < 0.001 BUΝ Baseline (mmol/L) 5.88 ± 1.25 5.94 ± 1.26 0.736 48 hours postprocedure 5.98 ± 1.33 6.00 ± 1.27 0.580 72 hours postprocedure 6.23 ± 0.75 7.56 ± 0.81 0.015 ΝGAL Baseline (µg/L) 87.62 ± 21.40 86.56 ± 20.12 0.662 48 hours postprocedure 95.35 ± 23.26 96.40 ± 21.25 0.302 72 hours postprocedure 112.15 ± 24.56 124.20 ± 25.78 0.018 CI-AKI (%) 13.88% 5.15% 0.024 Contrast volume 106.9 ± 22.8 110.3 ± 23.3 0.653 Table 3 presents findings from analyses using both univariate and multivariate logistic regression to evaluate risk factors impacting the incidence of CI- AKI. The univariate analysis highlighted that the use of SGLT2 inhibitors(OR = 0.294, 95%CI 0.133–0.647, P = 0.002) serve as protective measures against CI- AKI, Age level (OR = 1.069, 95% CI 1.028–1.112, p < 0.001), history of MI (OR = 2.428, 95%CI 1.157–5.099,P = 0.019), BNP level(OR = 1.001, 95%CI 1.000- 1.001,P = 0.002), fasting glucose(OR = 1.175,9 5%CI 1.001–1.380,P = 0.048), Hcy (OR = 1.076, 95%CI1.035-1.119,p = 0.001), ALT(OR = 1.008,95%CI1.001-1.014,P = 0.031), AST (OR = 1.008, 95%CI 1.003–1.013,P = 0.002) were independent predictors for the development of CI-AKI. Table 3 Univariate and Multivariate Predictors of Contrast-induced Nephropathy in Patients with Diabetes Mellitus. Characteristics Univariate Analysis Multivariate Analysis OR 95%CI P OR 95%CI P Age 1.069 1.028–1.112 < 0.001 1.070 1.020–1.122 0.005 Gender 0.612 0.303–1.235 0.170 Historyof Hypertension 0.782 0.381–1.606 0.503 History of MI 2.428 1.157–5.099 0.019 1.606 0.549–4.695 0.387 History of CKD 2.315 1.008–5.316 0.048 SGLT2i(%) 0.294 0.133–0.647 0.002 0.242 0.095–0.614 0.003 CCB (%) 1.250 0.618–2.530 0.535 ACEI/ARB (%) 1.118 0.554–2.257 0.755 Beta blocker(%) 0.565 0.276–1.159 0.120 Diuretics (%) 1.310 0.584–2.948 0.512 Metformin (%) 1.237 0.450–3.401 0.681 Acarbose (%) 0.937 0.345–2.546 0.899 Asprin (%) 0.562 0.280–1.130 0.106 Clopidogrel (%) 0.899 0.424–1.904 0.780 Ticagrelor (%) 0.738 0.294–1.853 0.517 Uric acid 1.001 0.998–1.004 0.689 BNP 1.001 1.000−1.001 0.002 1.001 1.000−1.001 0.030 Total cholesterol 1.213 0.970–1.515 0.090 Triglyceride 0.949 0.737–1.122 0.685 HDL-C 1.467 0.575–3.744 0.423 LDL-C 1.268 0.865–1.858 0.224 HbA1c 1.285 0.919–1.794 0.142 Fasting glucose 1.175 1.001–1.380 0.048 1.115 0.921–1.351 0.265 Homocysteine 1.076 1.035–1.119 0.010 1.053 1.010–1.098 0.016 Lipoprotein(a) 1.000 0.999–1.002 0.546 ALT 1.008 1.001–1.014 0.031 1.006 0.999–1.013 0.092 AST 1.008 1.003–1.013 0.002 0.998 0.987–1.009 0.687 CCB, calcium channel blockers;Alanine Aminotransferase,ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; ApoAI, apolipoprotein A-I;eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein; LDL-C,low-density lipoprotein; CKD,chronic kidney disease;ALT, Alanine Aminotransferase;AST, Aspartate Aminotransferase;HbA1c, glycated hemoglobin A1c;BNP, brain natriuretic peptide. In contrast, detailed findings from the multivariate analysis in Table 3 show that certain factors, including age (95% CI: 1.009–1.109, OR = 1.058, P = 0.02), b-type natriuretic peptide levels (95% CI: 1.000-1.001, OR = 1.001, P = 0.004), and homocysteine levels (95% CI: 1.010–1.098, OR = 1.053, P = 0.016), correlate with an increased risk of CI-AKI. Conversely, the application of SGLT2 inhibitors is reaffirmed as a protective factor, significantly reducing the risk of CI-AKI, with an OR of 0.242 (95% CI: 0.095–0.614; p = 0.003, detailed in Table 3 ). Results of subgroup analysis To assess whether CI- AKI risks differ among various patient demographics, subgroup analyses were conducted, as outlined in Table 4 . These analyses considered multiple variables, including the usage of ACE inhibitors/ARBs, levels of LVEF, age, sex, the use of diuretics, statins, acarbose and uric acid levels. Results demonstrated that subgroups of patients using SGLT2 inhibitors consistently showed a reduced risk of developing CI-AKI compared to those not using these inhibitors. This trend remained stable across all subgroups analyzed. Table 4 subgroup analysis the risk of CI-AKI in patients with diabetes who had undergone CCTA. Subgroups SGLT2i(-) SGLT2i(+) OR(95%CI) P-Value P for interaction ACEI/ARB No 12/79 (15.2) 3/63 (4.8) 0.28 (0.08–1.04) 0.057 0.960 Yes 15/82 (18.2) 6/98 (6.1) 0.29(0.11–0.79) 0.015 LVEF group 60 12/94 (12.8) 4/70 (5.7) 0.41 (0.13–1.34) 0.142 Age group < 65years 6/81 (7.4) 1/72 (1.4) 0.18 (0.02–1.50) 0.112 0.700 ≥ 65years 21/80 (26.2) 8/89 (9.0) 0.28 (0.12–0.67) 0.004 Sexy group female 11/52 (21.2) 5/58 (8.6) 0.35 (0.11–1.09) 0.071 0.621 male 16/109 (14.7) 4/103 (3.9) 0.23 (0.88−0.73) 0.012 Uric acid =378.61 12/84 (14.3) 7/77 (9.1) 0.60 (0.22–1.61) 0.311 Diuretics No 21/141 (14.9) 6/114 (5.3) 0.32 (0.12–0.82) 0.017 0.447 Yes 6/20 (30) 3/47 (6.4) 0.16 (0.04–0.72) 0.017 Metformin No 27/205(13.2) 4/79(5.1) 0.35(0.12–1.04) 0.059 0.756 Yes 4/20(20.0) 1/18(5.6) 0.24(0.02–2.34) 0.217 Statins No 13/49 (26.5) 2/43 (4.7) 0.14 (0.03–0.64) 0.012 0.202 Yes 14/112 (12.5) 7/118 (5.9) 0.44 (0.17–1.14) 0.091 Acarbose No 24/158 (15.2) 7/117(6.0) 0.36(0.15–0.86) 0.021 0.983 Yes 3/3 (100) 2/44(4.5) 0.00 (0.00-Inf) 0.995 History of CKD No 20/147 (13.6) 7/130 (5.4) 0.36 (0.15–0.89) 0.026 0.103 Yes 7/14 (50) 2/31 (6.5) 0.07 (0.01–0.41) 0.003 4. Discussion In this randomized study, we observed that short-term administration of dapagliflozin significantly reduced the incidence of CI-AKI in diabetic patients undergoing CCTA. Patients receiving SGLT2 inhibition demonstrated more favorable post-procedural renal function trajectories, with lower serum creatinine and higher eGFR values compared with placebo. Importantly, age, BNP, and homocysteine were identified as independent predictors of CI-AKI, emphasizing the multifactorial nature of renal injury in this setting. These results suggest that SGLT2 inhibitors may provide an additional pharmacological option to complement established preventive strategies such as hydration and careful contrast dosing. CCTA is a contemporary and convenient examination that has been commonly used for detecting coronary atherosclerosis and is increasingly essential for the diagnosis of CHD, risk stratification, and decision-making regarding revascularization [ 11 ] . However, any repetitive use of CCTA must be approached with special caution because this examination requires the use of a relatively high dose of iodine-containing contrast media [ 12 ] . In addition, some patients are required to undergo subsequent diagnostic coronary angiography and/or therapeutic coronary angioplasty, which raises concerns about additional exposure to contrast media [ 13 ] . Thus, the early method to protect renal function from deterioration prior to this examination is important. Diabetes mellitus is well established as a major risk factor for CI-AKI,even in patient with preserved renal function [ 14 ] . Paolisso observed a slightly higher overall AKI incidence in diabetes patients without CKD (7%), with rates up to 17% among those with concomitant CKD [ 15 ] .Diabetic patients are at increased risk of AKI due to underlying endothelial dysfunction, heightened systemic inflammation, and altered renal hemodynamics associated with both diabetes [ 16 , 17 ] . In the realm of cardiac care, for vulnerable individuals, even slight, transient renal injuries induced by contrast can significantly affect renal health [ 18 ] . Previous research indicated that out of 580 sequential patients undergoing CCTA, fifty-seven (9.83%) developed CI-AKI, with diabetic patients constituting 59.3% of these cases [ 19 ] . In the course of our study, we recorded a CI-AKI rate of 11.18%. Notably, the rate of CI-AKI in diabetic patients who were administered SGLT2 inhibitors was observed to be 5.15%. Despite advancements in CCTA protocols to address concerns about radiation, reducing the prevalence of CI-AKI continues to be a significant challenge. SGLT2 inhibitors enhance renal glucose elimination by preventing its reabsorption in the kidneys, thereby lowering serum glucose levels [ 20 ] . Multiple randomized controlled trials have shown that SGLT2 inhibitors, regardless of diabetes status, significantly decrease the risk of CKD progression or mortality compared to placebo [ 21 ] . A meta-analysis involving 2,572 diabetic patients who underwent CAG indicated that SGLT2 inhibitors significantly reduce the risk of developing CI-AKI [ 22 ] . However, variability exists in the type, dosage, and timing of SGLT2 inhibitor administration and the protective results of CI-AKI across different studies [ 23 ] . Hosseini [ 24 ] et al found short term (2 days) effects of empagliflozin could reduce the CI-AKI in patients undergoing PCI, and the diabetes participants in the study was relative small (28.1%). Zhao [ 25 ] et al also reported dapagliflozin exerted robust cardioprotective effects in patients with T2DM and chronic coronary syndrome undergoing percutaneous coronary intervention, but it did not significantly reduce the risk of CI-AKI. In our study, the including patients were all diagnosed with diabetes, and contrast volume was relative smaller than PCI surgery, that is also the novelty of our study. Recent studies have shown that within the first 24 hours of using contrast media, direct toxic effects can induce occlusions in the tubular structures of proximal tubule cells and lead to mitochondrial dysfunction [ 26 ] . SGLT2 inhibitors could induce a rapid decline in eGFR during the early phase in clinical trials, and the protective effect was reversible after SGLT2i withdrawal [ 27 ] .While the exact mechanisms through which SGLT2 inhibitors shield the kidneys remain partially unclear, Huang X et al demonstrated that dapagliflozin ameliorate CI-AKI through suppression of HIF-1a/HE4/NF-kB signaling in vitro and in vivo, which is the pathway involved in hypoxia-induced injury [ 28 ] .Canagliflozin potentially promotes renal protection against glycerol-induced acute kidney injury by activating the AMPK/ SIRT1/ FOXO-3a/PGC-1a and Nrf2/HO-1 pathways [ 29 ] . Furthermore, dapagliflozin inhibit sodim reabsorption in the proximal tubule, leads to afferent arteriolar vasoconstriction [ 30 ] . Additionally, SGLT2 inhibitors possess anti-inflammatory, antifibrotic, and antioxidative properties, contributing to their ability to safeguard the kidneys from damage triggered by contrast media [ 31 ] .However, the mechanism by which short-acting statins exert a protective effect against contrast-induced nephropathy after CCTA still needs further investigation. Recent developments in risk stratification systems for CI-AKI have included various scoring models such as the CHA2DS2-VASc score, Thrombolysis in Myocardial Infarction risk index, and Mehran's score system [ 32 ] . However, these scoring systems have primarily been applied to patients undergoing PCI and non-diabetes patients. In the present study, it was observed that elderly individuals, along with those exhibiting elevated BNP level and plasma homocysteine levels, were more susceptible to developing CI-AKI during CCTA in diabetic patients. Previously, plasma homocysteine was not as prominently considered in above mentioned scoring systems. In a study led by Barbieri et al [ 33 ] , which included 876 patients with reduced renal function (eGFR < 60ml/min) undergoing CAG, a notable correlation was discovered between elevated homocysteine levels and the incidence of CI-AKI. Our results also indicated that homocysteine serves as an independent biomarker for predicting CI-AKI in patients post-CCTA. When considered alongside previous evidence, our results are broadly consistent with recent meta-analyses and registry data showing that SGLT2 inhibitors reduce CI-AKI risk in diabetic patients undergoing coronary angiography or PCI. However, our trial differs in that it specifically evaluated CCTA patients, a population less studied despite growing use of this modality in routine clinical practice. The observed benefit in this setting underscores the potential for expanding renoprotective strategies beyond invasive procedures, thereby improving the safety profile of non-invasive imaging renal microcirculation, all of which amplify the nephrotoxic effects of iodinated contrast. Several limitations must be acknowledged. This was a single-center study with a moderate sample size, which may restrict generalizability. Although we identified BNP and homocysteine as predictors, we did not evaluate additional early biomarkers of renal injury, such as cystatin C or γ-glutamyltranspeptidase (GGT), which could provide further mechanistic insights. Moreover, the study only investigated short-term outcomes; whether peri-procedural use of SGLT2 inhibitors translates into long-term renal and cardiovascular benefits requires confirmation. Future large-scale, multicenter randomized trials are needed to validate these findings, clarify the optimal drug type, dose, and timing, and integrate pharmacological protection into standardized CCTA protocols. 6. Conclusion This study has established that the short-term use of SGLT2 inhibitors plays a significant role in reducing the incidence of contrast-induced acute kidney injury among diabetic patients who undergo CCTA. Declarations Author contributions Original draft -Tian zheng,Qianghui Huang; Data curation- YuXuan Zhong,LiFeng Zhang ,Xiao Huang, Conceptualization- Jianxin Hu, Xiaoshu Cheng;Supervision- Biming Zhan. Acknowledgments We acknowledge the dedicated work of all the authors that implemented the intervention and evaluation components of the study. Disclosure statement We declare that we have no conflict of interest. The project was supported by funding from the following: the National Natural Science Foundation of China [82060075]; Jiangxi Provincial Natural Science Foundation [20212BAB216057]；The Second Affiliated Hospital Of NanChang University Funding Program[2022efyC07]；2021 SKY Imaging Research Fund of the Chinese Internatinal Medical Foundatin Data availability statement the datasets analyzed during the current study are available from the corresponding author, upon reasonable request. References Wininger Kevin L, Carpenter Stefanie.Background and Clinical Implications of CCTA and CT-based Fractional Flow Reserve.RADIOL TECHNOL. 2024-09-01;96(1):25-36. Gohmann Robin F, Schug Adrian, Pawelka Konrad,et al.Interrater variability of ML-based CT-FFR during TAVR-planning: influence of image quality and coronary artery calcifications.Front Cardiovasc Med. 2023-01-01;10:1301619. Frydman Shir, Freund Ophir, Katash Haytham Abu,et al. Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors.CLIN CARDIOL. 2024-10-01;47(10):e70002. Fraenkel Yedidah, Bogot Naama R, Kuint Ruth Cytter,et al. Post-contrast acute kidney injury in the super-elder patients: a CT-scan perspective.JPN J RADIOL. 2024-09-12. Chen Lan, Zhao Junlu, Lu Liyun,et al. Association between normal saline infusion volume in the emergency department and acute kidney injury in heat stroke patients: a multicenter retrospective study.RENAL FAILURE. 2024-12-01;46(1):2294151. Wang Heng; Gao, Tingting, Zhang Ruijing,et al. The intellectual base and global trends in contrast-induced acute kidney injury: a bibliometric analysis.RENAL FAILURE. 2023-12-01;45(1):2188967. Kilickap Mustafa, Kozluca Volkan,Tan Türkan Seda,et al. GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Patients With Versus Without Cardiovascular Disease: A Systematic Review, Meta-analysis, and Trial Sequential Analysis.ANGIOLOGY. 2024-10-01; 75(9): 820-830. Starr Jessica A, Pinner Nathan A. The Impact of SGLT2 Inhibitors on Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.ANN PHARMACOTHER. 2024-05-01;58(5):506-513. Meregildo-Rodriguez Edinson Dante, Asmat-Rubio Martha Genara, Vásquez-Tirado Gustavo Adolfo,et al.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). 2023-01-01;14:1307715. Paolisso Pasquale, Bergamaschi Luca, Cesaro Arturo,et al. Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction with and without chronic kidney disease: Insight from SGLT2-I AMI PROTECT registry. DIABETES RES CLIN PR. 2023-08-01;202:110766. Nozaki Yui O,Fujimoto Shinichiro,Takahashi Daigo,et al. Additional prognostic impact of plaque characterization with on-site CT-derived fractional flow reserve in coronary CT angiography.J CARDIOL. 2024-11-01;84(5):336-341. Belmonte Marta,Paolisso Pasquale, Gallinoro Emanuele,et al. Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA).J CARDIOVASC COMPUT. 2024-10-09. Frydman Shir, Freund Ophir, Katash Haytham Abu,et al. Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors. CLIN CARDIOL. 2024-10-01;47(10):e70002. Lee ChengChia, Chan Yi-Ling, Wong Yon-Cheong,et al. Contrast-enhanced CT and Acute Kidney Injury: Risk Stratification by Diabetic Status and Kidney Function. RADIOLOGY. 2023-06-01;307(5):e222321. Paolisso P, Belmonte M, Gallinoro E, et al. Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Cardiovasc Diabetol. 2025 May 21;24(1):221. Li Y, Ren K. The Mechanism of Contrast-Induced Acute Kidney Injury and Its Association with Diabetes Mellitus.Contrast Media Mol Imaging. 2020 Jun 23;2020:3295176. Tang H, Chen H, Li Z, et al.Association between uric acid level and contrast-induced acute kidney injury in patients with type 2 diabetes mellitus after coronary angiography: a retrospective cohort study.BMC Nephrol. 2022 Dec 12;23(1):399. Pakfetrat M, Nikoo MH, Malekmakan L,et al. Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes. Cheng Chun-Han, Hao Wen-Rui, Cheng Tzu-Hurng,et al. Innovative approaches beyond periprocedural hydration for preventing contrast-induced acute kidney injury.World J Radiol. 2024-09-28;16(9):375-379. Isobe Satoshi, Yamada Takashi,Yuba Miyuki,et al.Relationship between pre-procedural microalbuminuria and renal functional changes after coronary computed tomography in diabetic patients.J CARDIOL. 2017-04-01;69(4):666-670. Koshizaka Masaya,Tatsumi Tomoaki, Kiyonaga Fumiko,et al. Comparison of the Risk of Diabetic Retinopathy Between Sodium-Glucose Cotransporter-2 Inhibitors and Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus in Japan: A Retrospective Analysis of Real-World Data.DIABETES THER. 2024-11-01;15(11):2401-2416. El Khayari Abdellatif, Hakam Soukaina Miya,et al. New insights into the cardio-renal benefits of SGLT2 inhibitors and the coordinated role of miR-30 family. GENES DIS. 2024-11-01;11(6):101174. Pakfetrat M, Nikoo MH, Malekmakan L, et al. Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes.Hemodial Int. 2010 Oct;14(4):387-92. Lin Donna Shu-Han, Lee Jen-Kuang, Chen Wen-Jone.Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals.J CLIN ENDOCR METAB. 2021-06-16; 106 (7): 2133-2145. Yen Fu-Shun,Hwu Chii-Min, Liu Jia-Sin,et al.Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease.ANN INTERN MED. 2024-06-01;177(6):693-700. Hosseini Zeinab Sadat,Jamili Mohammad Javad, Ensan, Behzad,et al.Short-term effects of empagliflozin on preventing contrast induced acute kidney injury in patients undergoing percutaneous coronary intervention, a randomised trial.Sci Rep. 2025-01-31;15 (1): 3940. Yen Fu-Shun,Hwu Chii-Min, Liu Jia-Sin,et al. Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease.ANN INTERN MED. 2024-06-01;177(6):693-700. Jensen Simon Kok, Heide-Jørgensen Uffe, Andersen Ina Trolle,et al.#462 Initiation of SGLT2i vs GLP1-RA and incidence of AKI in persons with type 2 diabetes mellitus.NEPHROL DIAL TRANSPL. 2024-05-23;39(Supple1) Wang Qian, Yu Jianmin, Deng Weizhu,et al. Influence of sodium/glucose cotransporter-2 inhibitors on the incidence of acute kidney injury: a meta-analysis.Front Pharmacol. 2024-01-01;15:1372421. Wang Tiansheng, Ji Dongze, Stürmer Til,et al. The Effect of Sodium Glucose Cotransporter-2 Inhibitors on Hemoglobin A1c Variability and Acute Kidney Injury: A Causal Mediation Analysis.PHARMACOEPIDEM DR S. 2024-08-01;33(8):e5876. Li Jing, Wang Zhen, Zhang BaiXiang,et al.Predictive value of combining the level of fibrinogen and CHA2DS2-VASC Score for contrast-induced acute kidney injury in patients with acute coronary syndromes undergoing percutaneous coronary intervention.INT UROL NEPHROL. 2022-09-01;54(9):2385-2392. Zhu Yinghua,Qiu Hang,Wang Zhen,et al. Predictive value of systemic immune-inflammatory index combined with CHA2DS2-VASC score for contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention.INT UROL NEPHROL. 2023-11-01;55(11):2897-2903. Huang X, Guo X, Yan G,et al. Dapagliflozin Attenuates Contrast-induced Acute Kidney Injury by Regulating the HIF-1α/HE4/NF-κB Pathway.J Cardiovasc Pharmacol. 2022 Jun 1;79(6):904-913. Bishr A, Atwa AM, El-Mokadem BM, El-Din MN. Canagliflozin potentially promotes renal protection against glycerol-induced acute kidney injury by activating the AMPK/SIRT1/FOXO-3a/PGC-1α and Nrf2/HO-1 pathways. Naunyn Schmiedebergs Arch Pharmacol. 2025 Apr 21. doi: 10.1007/s00210-025-04017-x. Epub ahead of print. PMID: 40257493. Gholam MF, Liu LP, Searcy LA, et al.Dapagliflozin Treatment Augments Bioactive Phosphatidylethanolamine Concentrations in Kidney Cortex Membrane Fractions of Hypertensive Diabetic db/db Mice and Alters the Density of Lipid Rafts in Mouse Proximal Tubule Cells.Int J Mol Sci. 2023 Jan 11;24(2):1408. Han JX, Luo LL, Wang YC, et al.SGLT2 inhibitor empagliflozin promotes revascularization in diabetic mouse hindlimb ischemia by inhibiting ferroptosis.Acta Pharmacol Sin. 2023 Jun;44(6):1161-1174. Zhu Y, Qiu H, Wang Z, et al. Predictive value of systemic immune-inflammatory index combined with CHA2DS2-VASC score for contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Int Urol Nephrol. 2023 Nov;55(11):2897-2903. Mo Changhua, Ma Xiao, Jian Wen, et al.High mobility group box 1 and homocysteine as preprocedural predictors for contrast-induced acute kidney injury after percutaneous coronary artery intervention.INT UROL NEPHROL. 2022-07-01;54(7):1663-1671. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7694999","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":550069278,"identity":"55874b68-c10e-4773-9d5d-7c2dc044d408","order_by":0,"name":"Tian zheng","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"Tian","middleName":"","lastName":"zheng","suffix":""},{"id":550069279,"identity":"9d81ffe8-6953-487f-b6b7-860437f28fcd","order_by":1,"name":"LiFeng Zhang","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"LiFeng","middleName":"","lastName":"Zhang","suffix":""},{"id":550069280,"identity":"0add6046-b6e9-47cd-85e4-8dd1c254dd7b","order_by":2,"name":"YuXuan Zhong","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"YuXuan","middleName":"","lastName":"Zhong","suffix":""},{"id":550069281,"identity":"eeba2bb9-58e3-4a96-ac63-3f08f4472ba8","order_by":3,"name":"Xiaoshu Cheng","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"Xiaoshu","middleName":"","lastName":"Cheng","suffix":""},{"id":550069282,"identity":"fce9d312-4fb9-4912-b0fc-f676f75d034c","order_by":4,"name":"Jianxin Hu","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"Jianxin","middleName":"","lastName":"Hu","suffix":""},{"id":550069283,"identity":"84cd88ad-8714-40e0-9001-d20af4468618","order_by":5,"name":"Lianggeng Gong","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"Lianggeng","middleName":"","lastName":"Gong","suffix":""},{"id":550069284,"identity":"e26c018e-5413-4b24-a5bd-77fbef6c274c","order_by":6,"name":"Qianghui Huang","email":"","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":false,"prefix":"","firstName":"Qianghui","middleName":"","lastName":"Huang","suffix":""},{"id":550069285,"identity":"35cfe03d-8d6e-47ab-adda-879c365e9db9","order_by":7,"name":"Biming Zhan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDCCAwxsIJKHgRlIfTCwsSNNC+OMgrRkorWA2cw8Hw4xNhDSwXf7+LMHP3fckdFt5z382sbgADMD++GjG/BpkTyXkG7Ye+YZj9lhvjTrHIM7fAw8aWk38GkxOMNwTIK37TBQC4+ZcY7BM2YGCR4zAloY2yT/wrRYGBxmbCCshZlNGmqL8WMGYrRInmFjk5Ztewa2hbHHIC2ZjZBf+M6wP5N823bH3uz8GeMPP/7Y2PGzHz6GVwsyYJMAk8QqBwHmD6SoHgWjYBSMgpEDAJZiSrf83CY+AAAAAElFTkSuQmCC","orcid":"","institution":"the second affiliated hospital,jiangxi medical college, nanchang university","correspondingAuthor":true,"prefix":"","firstName":"Biming","middleName":"","lastName":"Zhan","suffix":""}],"badges":[],"createdAt":"2025-09-23 13:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7694999/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7694999/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96919287,"identity":"1992329b-d784-4591-8c9d-0ab9af91e574","added_by":"auto","created_at":"2025-11-27 14:13:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":48827,"visible":true,"origin":"","legend":"","description":"","filename":"TheEffectofshorttermSGLT2Inhibitorsmanuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/b966f964624bdffa17fda854.docx"},{"id":96919657,"identity":"3457a0a7-bfaa-44ea-81a7-fec2012ffa0d","added_by":"auto","created_at":"2025-11-27 14:14:17","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155130,"visible":true,"origin":"","legend":"","description":"","filename":"Figure10903.tif","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/7975586bf30fb857d708d766.tif"},{"id":96845187,"identity":"99196a5c-0b6a-4ac5-ad28-085262c81e7c","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40791,"visible":true,"origin":"","legend":"","description":"","filename":"tables0903.docx","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/24a601d3dc9d41f8449d3cc0.docx"},{"id":96845190,"identity":"317fd1a6-dbb7-4607-9447-2ee37aa6e561","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8774,"visible":true,"origin":"","legend":"","description":"","filename":"21c503ddc9ed417b91fcb882f5de6c07.json","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/08a08844356ca7fbc836a36e.json"},{"id":96845193,"identity":"90bf541a-9f3f-4ab5-9077-4ec58649afcc","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":130443,"visible":true,"origin":"","legend":"","description":"","filename":"21c503ddc9ed417b91fcb882f5de6c071enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/67860c406bee0cfa794164d0.xml"},{"id":96845192,"identity":"b3ac8da0-7581-462a-82c3-479538c43ad1","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"tif","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155130,"visible":true,"origin":"","legend":"","description":"","filename":"Figure10903.tif","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/4fc9cd4f778124bf3c2aa578.tif"},{"id":96845189,"identity":"e2771220-f6d1-4d6d-9f27-b413748eb667","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22725,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFigure10903.png","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/25b50b56a6631a327079edff.png"},{"id":96845194,"identity":"bf4489a4-f8dd-475b-8752-5f13bf9ed6cc","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128568,"visible":true,"origin":"","legend":"","description":"","filename":"21c503ddc9ed417b91fcb882f5de6c071structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/b0856a441362df665120ad14.xml"},{"id":96917249,"identity":"a01b8424-954c-4fe7-85a3-dd2aba2836b3","added_by":"auto","created_at":"2025-11-27 14:09:26","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":139637,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/82b5b73e790b7bf270158ae0.html"},{"id":96845186,"identity":"b5eebb08-4a75-4bb7-bd02-924d1365eab0","added_by":"auto","created_at":"2025-11-26 16:32:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81356,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure10903.png","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/ccf010571fc37efdb4fe4bf1.png"},{"id":97136221,"identity":"7db4f7b2-1692-465b-b935-7b7395949d9d","added_by":"auto","created_at":"2025-12-01 09:56:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1198653,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7694999/v1/5c1b0482-1ba8-4ee1-be9d-a844201b9067.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of short-term SGLT2 Inhibitors therapy on the Development of Contrast-induced acute kidney injury in Diabetic Patients undergoing Coronary computed tomographic angiography：a prospective study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCoronary computed tomographic angiography(CCTA) is largely used as the first line of diagnostic approach in patients with low pretest probability for coronary heart disease\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. CCTA continues to evolve with the integration of deep learning and AI technology, broadening its applicability in the standardized CT protocol for transcatheter aortic valve replacement (TAVR) planning and the identification of other vulnerable plaques in myocardial infarction patients\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. A relevant issue that has recently garnered attention is contrast-induced acute kidney injury (CI-AKI), which has been reported to occur frequently with the use of contrast media in CCTA\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCI-AKI is considered a new-onset or exacerbation of renal dysfunction following the administration of contrast media, without other potential causes.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. This condition ranks as the third most frequent cause of acute kidney injury acquired within hospital settings\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In 2023, Wang et al. conducted a comprehensive bibliometric analysis of the current state of research in the field of CI-AKI. They included 4,775 CI-AKI-related articles, and recent focus has been placed on risk factors for CI-AKI, prevention and treatment strategies, evaluation of the effects of contrast media and potential mechanisms of injury\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, the specific incidence and associated risks of CI- AKI among diabetic patients receiving CCTA have yet to be determined.\u003c/p\u003e\u003cp\u003eSodium/glucose co-transporter 2 (SGLT2) inhibitors, originally designed for the management of type 2 diabetes, have been shown to significantly lower the rates of heart failure admissions, cardiovascular mortality among individuals with or without diabetes, thereby extending their clinical benefits to robust cardio-renal outcomes\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Among patients with heart failure with mildly reduced ejection fraction (HFmrEF) or Heart failure with preserved ejection fraction(HFpEF) treated with dapagliflozin, an initial decline in eGFR and a reduction in urinary albumin are commonly observed\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Emerging research indicates that SGLT2 inhibitors might diminish the likelihood of CI- AKI in diabetic patients undergoing coronary angiography (CAG)or percutaneous coronary intervention(PCI) \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e,and Paolisso et al found the use of SGLT2-I was associated with a lower risk of CI-AKI in diabetic patients with acute myocardial infarction, and the protective effects appear more prominent in patients without chronic kidney disease \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAlthough recent progress has been observed, there is still a significant lack of information about the impact of SGLT2 inhibitors on the prevalence of CI-AKI among CCTA patients. Consequently, our study is aimed at evaluating how SGLT2 inhibitors might influence the occurrence of CI-AKI in the diabetes population.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cb\u003eEthics statement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur clinical research is registered in the Chi CTR,NO.2500098100. This study was approved by the Institutional Review Board (IRB) of Nanchang University's Second Affiliated Hospital, approval number code N-202007038. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individuals before they enrolled in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCharacteristics of the study population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis prospective study was conducted at a single healthcare facility, examining 352 patients diagnosed with Type 2 DM, were subjected to CCTA between January 1, 2024, and January 1, 2025. Of the patients in experimental group, patients were given dapagliflozin SGLT2 inhibitor, at a dose of 10 mg once a day. This treatment was initiated at 3 days prior to their CCTA. The other patients who form the control group were taken a placebo table, was similar in terms of color, shape, and packaging to dapagliflozin .\u003c/p\u003e\u003cp\u003eAfter excluding patients with missing data and those who could not complete follow-up, a total of 312 participants were analyzed (Fig.\u0026nbsp;1).The duration of medication use prior to CCTA was verified using electronic health records. The primary outcome of our study was to compare the incidence of CI-AKI between two groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudy participants were included patients who were clinically diagnosed with T2DM and underwent CCTA ,experiencing angina and chest pain. The criteria for inclusion required that candidates be adults aged 18 or older with stable vital signs, a clear understanding of the study's procedures, and a demonstrated ability to comply with study requirements.\u003c/p\u003e\u003cp\u003eExclusion criteria included individuals diagnosed with suffering from severe heart failure, as classified by the New York Heart Association at a level III or higher; end-stage kidney disease;Already on SGLT2 inhibitors; kidney replacement therapy, missing data and those with a known allergy to contrast agents.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRandomization and blinding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStratified block randomization was used to allocate eligible subjects. Closed envelopes marked with A or B labels were employed for the placebo and intervention groups, respectively. The envelopes were opened sequentially in the presence of each participant. The allocation list, maintained by the faculty of Medicine, was secure, and researchers were denied access until the conclusion of the study. This method effectively ensured that both patients and investigators were blinded to treatment allocation, preserving the integrity of the blinding process.\u003c/p\u003e\u003cp\u003eBased on previous studies, the estimated incidence rates in the exposed and unexposed groups are set as p1and p2, respectively. The effect size is defined as ES = |p1- p2|.A two - sided significance level of α\u0026thinsp;=\u0026thinsp;0.05 is set, corresponding to a 95% confidence level. the sample size formula is:N=(\u003cem\u003ep\u003c/em\u003e1​\u0026minus;\u003cem\u003ep\u003c/em\u003e2​)2(\u003cem\u003eZ\u003c/em\u003e1\u0026thinsp;\u0026minus;\u0026thinsp;\u003cem\u003eα\u003c/em\u003e/2​2\u003cem\u003ep\u003c/em\u003eˉ​(1\u0026thinsp;\u0026minus;\u0026thinsp;\u003cem\u003ep\u003c/em\u003eˉ​)​+\u003cem\u003eZ\u003c/em\u003e1\u0026thinsp;\u0026minus;\u0026thinsp;\u003cem\u003eβ\u003c/em\u003e​\u003cem\u003ep\u003c/em\u003e1​(1\u0026thinsp;\u0026minus;\u0026thinsp;\u003cem\u003ep\u003c/em\u003e1​)\u0026thinsp;+\u0026thinsp;\u003cem\u003ep\u003c/em\u003e2​(1\u0026thinsp;\u0026minus;\u0026thinsp;\u003cem\u003ep\u003c/em\u003e2​)​)2​\u003c/p\u003e\u003cp\u003eConsidering the calculation results and practical feasibility, a total of 322 participants (161 in each of the exposed and unexposed groups) will be enrolled in this study to ensure sufficient statistical power.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcquisition and analyses of coronary CTA\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCoronary artery calcification was assessed in all participants. The scan settings included a tube voltage ranging from 100\u0026ndash;120 kV, a tube current between 100\u0026ndash;300 mAs, and a collimator set at 128\u0026times;0.625 mm. The X-ray tube rotated at a speed of 0.27 seconds per revolution, with a resolution matrix of 512\u0026times;512. For contrast enhancement, a non-ionic contrast medium, iophorol (370mg/mL, produced by Jiangsu Hengrui in Lianyungang, China), was administered at a rate of 4\u0026ndash;5 mL/s, followed by an equivalent flow of 50 mL saline. An artificial intelligence system initiated the delay timing, targeting the ascending aorta at the primary pulmonary window as the area for dynamic monitoring. The scanning process automatically commenced once the CT value reached 150 HU, after a 6-second pause\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRisk factors and laboratory analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInitial assessments employed standardized surveys to gather information on patient demographics, use of medications, and their smoking and alcohol consumption habits. The diagnostic criteria for hypertension in this study included any patient with a SBP of 140 mm Hg or above, a DBP of 90 mm Hg or more, or those undergoing treatment with antihypertensive medications. Hyperlipidemia was defined as TC\u0026thinsp;\u0026ge;\u0026thinsp;6.22 mmol/L, TG\u0026thinsp;\u0026ge;\u0026thinsp;2.26 mmol/L, and LDL-C\u0026thinsp;\u0026ge;\u0026thinsp;4.14 mmol/L, or patients were prescribed lipid-lowering drugs. Throughout hospitalization, each patient underwent a detailed transthoracic echocardiography using the advanced Vivid 5 system by GE Vingmed Ultrasound AS, based in Horten, Norway. This echocardiography employed the biplane Simpson method to accurately measure the LVEF. Moreover, laboratory evaluations comprising blood counts, homocysteine levels, lipid profiles, renal function, and glucose tests were conducted before and 48 hours,72 hours after the CCTA.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDefinition of Outcome\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome was the occurrence of the first Acute Kidney Injury (AKI) event during hospitalization. We identified Contrast-Induced Acute Kidney Injury (CI-AKI) events using a laboratory-based algorithm that adheres to the European Society of Urogenital Radiology (ESUR) serum creatinine criteria. (This criteria defines CI-AKI events as an increase in serum creatinine by \u0026ge;\u0026thinsp;44.2 \u0026micro;mol/L or 0.5 mg/dL within 72 hours, or an increase in serum creatinine by \u0026ge;\u0026thinsp;1.25 times the baseline value (hereafter referred to as CI-AKI-ESUR).\u003c/p\u003e\u003cp\u003eThe last laboratory values obtained before the patient underwent Coronary Angiography (CAG) served as the baseline data for analysis, ensuring the most accurate reflection of each patient's baseline renal function. The renal function parameters, including serum creatinine and urea nitrogen, NGAL were collected upon admission and measured at 24, 48, and 72 hours post-CAG using the VITROS5600 automatic biochemical immune analyzer (JNJ, New Jersey, US).\u003c/p\u003e\u003cp\u003eThe estimated Glomerular Filtration Rate (eGFR, in ml/min/1.73 m^2) was calculated using the Modification of Diet in Renal Disease (MDRD) equation: 186.3\u0026times;(serum creatinine in mg/dL)^-1.154\u0026times;(age in years)^-0.203\u0026times;(0.742 for women)\u0026times;(1.21 for blacks).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnalysis of the data was conducted utilizing SPSS software, release 26.0. Normality tests were utilized to determine the Gaussian distribution of the variables. Mean values and standard deviations described continuous variables, while categorical variables were expressed in percentages. Renal function outcomes were compared using the Student's t-test, and the chi-squared test was used to evaluate the quality of the images.Linear regression was performed to evaluate the relationship between the rate of CI-AKI and demographic, clinical, and procedural characteristics. Variables were selected for inclusion in a multivariable model based on their univariate associations (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Subsequently, variables that met predefined criteria for entry (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were incorporated into the final multivariable model, which was then assessed for goodness of fit using the R\u003csup\u003e\u0026minus;\u0026thinsp;squared\u003c/sup\u003e value. To determine if the risks of CI-AKI varied among different subgroups, analyses were performed based on various factors. In the statistical analysis conducted, a p-value below 0.05 was deemed significant for the purpose of two-tailed tests.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 352 diabetes participants underwent CCTA, of whom 322 participants successfully completed the study【Figure 1】. The median age was reported as 65.02\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89 years, with males comprising 65.8% (212 individuals). The occurrence rate of CI-AKI within the studied population stood at 11.20%. Notably, the prevalence of CI-AKI among individuals treated with SGLT2 inhibitors (treatment group, 5.15%) was markedly lower compared to those control group(13.88%), a difference that reached statistical significance (p\u0026thinsp;=\u0026thinsp;0.024). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e lists the rest of the demographic characteristics of the patients, clinical and laboratory parameters. The two groups had no significant demographic and clinical data differences.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparisons of baseline characteristics between the two groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTreatment group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale,n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67.70%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.97%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge,years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.11\u0026thinsp;\u0026plusmn;\u0026thinsp;10.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.93\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of CKD(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.09%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.79%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of Hypertension,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.11%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.49%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of myocardial infarction,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.31%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.90%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoker,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.74%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.25%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.679\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol,(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.93%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.87%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin level,g/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e132.34\u0026thinsp;\u0026plusmn;\u0026thinsp;19.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131.81\u0026thinsp;\u0026plusmn;\u0026thinsp;20.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.816\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal cholesterol, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriglyceride, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL-C,mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL-C, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.237\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUric acid,\u0026micro;mol/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e383.45\u0026thinsp;\u0026plusmn;\u0026thinsp;106.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e387.28\u0026thinsp;\u0026plusmn;\u0026thinsp;112.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.754\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFasting glucose,mmol/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.211\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c,%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.861\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLipoprotein(a),mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e163.07\u0026thinsp;\u0026plusmn;\u0026thinsp;56.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e165.26\u0026thinsp;\u0026plusmn;\u0026thinsp;46.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.455\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft ventricular ejection\u003c/p\u003e\u003cp\u003efraction, LVEF %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.26\u0026thinsp;\u0026plusmn;\u0026thinsp;10.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.455\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHomocysteine,umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.64\u0026thinsp;\u0026plusmn;\u0026thinsp;11.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.173\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT,U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.85\u0026thinsp;\u0026plusmn;\u0026thinsp;20.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.17\u0026thinsp;\u0026plusmn;\u0026thinsp;20.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.462\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST,U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.69\u0026thinsp;\u0026plusmn;\u0026thinsp;87.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.76\u0026thinsp;\u0026plusmn;\u0026thinsp;45.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.159\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACEi/ARB(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.33%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.59%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCB (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.75%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.16%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBeta blocker (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.86%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.278\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiuretics (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.00%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.27%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.88%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.53%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.680\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcarbose(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.68%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.76%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatins (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.33%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.07%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAspirin (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.44%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.68%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClopidogrel (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.92%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTicagrelor (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.98%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.410\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eALT, Alanine Aminotransferase;AST, Aspartate Aminotransferase;ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; CCB, calcium channel blocker; CKD, chronic kidney disease; ApoAI, apolipoprotein A-I;eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin A1c; HDL-C, high-density lipoprotein; LDL-C,low-density lipoprotein; CI-AKI, contrast induced acute kidney injury; BNP, brain natriuretic peptide.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e outlines the variations in Scr and eGFR measurements taken before and after CCTA. Initially, Scr(84.66\u0026thinsp;\u0026plusmn;\u0026thinsp;53.62 vs 82.32\u0026thinsp;\u0026plusmn;\u0026thinsp;35.56 umol/L) and GFR (78.87\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67 vs 78.69\u0026thinsp;\u0026plusmn;\u0026thinsp;22.19) readings showed no significant differences between the two groups prior to the CCTA. However, at 48 hours following the procedure, Scr values in the SGLT2i group(81.07\u0026thinsp;\u0026plusmn;\u0026thinsp;39.22) were notably lower than those in the control group (130.96\u0026thinsp;\u0026plusmn;\u0026thinsp;95.09, p\u0026thinsp;=\u0026thinsp;0.001). At this specific time point, a notable decline in GFR levels was observed in the SGLT2i group when compared with the control group(61.03\u0026thinsp;\u0026plusmn;\u0026thinsp;10.25 vs 51.02\u0026thinsp;\u0026plusmn;\u0026thinsp;13.34 )at 72 hours post CCTA, demonstrating statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). It can also be observed that 72 hours later, the levels of blood urea nitrogen (BUN) and neutrophil gelatinase-associated lipocalin (NGAL) in the sodium-glucose cotransporter 2 inhibitor (SGLT2i) group were significantly lower than those in the conventional treatment group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparisons of baseline characteristics between the two groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTreatment group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScr Baseline(\u0026micro;mol/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84.66\u0026thinsp;\u0026plusmn;\u0026thinsp;53.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.32\u0026thinsp;\u0026plusmn;\u0026thinsp;35.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.216\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e48h postprocedure Scr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130.96\u0026thinsp;\u0026plusmn;\u0026thinsp;95.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.07\u0026thinsp;\u0026plusmn;\u0026thinsp;39.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e72 hours postprocedure Scr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e149.34\u0026thinsp;\u0026plusmn;\u0026thinsp;43.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93.31\u0026thinsp;\u0026plusmn;\u0026thinsp;24.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eeGFR Baseline(mL/min)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78.87\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.69\u0026thinsp;\u0026plusmn;\u0026thinsp;22.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.985\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e48 hours postprocedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65.79\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.67\u0026thinsp;\u0026plusmn;\u0026thinsp;13.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.628\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e72 hours postprocedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.02\u0026thinsp;\u0026plusmn;\u0026thinsp;13.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.03\u0026thinsp;\u0026plusmn;\u0026thinsp;10.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBUΝ Baseline (mmol/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e48 hours postprocedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.580\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e72 hours postprocedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eΝGAL Baseline (\u0026micro;g/L)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87.62\u0026thinsp;\u0026plusmn;\u0026thinsp;21.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.56\u0026thinsp;\u0026plusmn;\u0026thinsp;20.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.662\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e48 hours postprocedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95.35\u0026thinsp;\u0026plusmn;\u0026thinsp;23.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96.40\u0026thinsp;\u0026plusmn;\u0026thinsp;21.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e72 hours postprocedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112.15\u0026thinsp;\u0026plusmn;\u0026thinsp;24.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124.20\u0026thinsp;\u0026plusmn;\u0026thinsp;25.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCI-AKI (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.88%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContrast volume\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.653\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents findings from analyses using both univariate and multivariate logistic regression to evaluate risk factors impacting the incidence of CI- AKI. The univariate analysis highlighted that the use of SGLT2 inhibitors(OR\u0026thinsp;=\u0026thinsp;0.294, 95%CI 0.133\u0026ndash;0.647, P\u0026thinsp;=\u0026thinsp;0.002) serve as protective measures against CI- AKI, Age level (OR\u0026thinsp;=\u0026thinsp;1.069, 95% CI 1.028\u0026ndash;1.112, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), history of MI (OR\u0026thinsp;=\u0026thinsp;2.428, 95%CI 1.157\u0026ndash;5.099,P\u0026thinsp;=\u0026thinsp;0.019), BNP level(OR\u0026thinsp;=\u0026thinsp;1.001, 95%CI 1.000- 1.001,P\u0026thinsp;=\u0026thinsp;0.002), fasting glucose(OR\u0026thinsp;=\u0026thinsp;1.175,9 5%CI 1.001\u0026ndash;1.380,P\u0026thinsp;=\u0026thinsp;0.048), Hcy (OR\u0026thinsp;=\u0026thinsp;1.076, 95%CI1.035-1.119,p\u0026thinsp;=\u0026thinsp;0.001), ALT(OR\u0026thinsp;=\u0026thinsp;1.008,95%CI1.001-1.014,P\u0026thinsp;=\u0026thinsp;0.031), AST (OR\u0026thinsp;=\u0026thinsp;1.008, 95%CI 1.003\u0026ndash;1.013,P\u0026thinsp;=\u0026thinsp;0.002) were independent predictors for the development of CI-AKI.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate and Multivariate Predictors of Contrast-induced Nephropathy in Patients with Diabetes Mellitus.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eUnivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eMultivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.028\u0026ndash;1.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.020\u0026ndash;1.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.303\u0026ndash;1.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistoryof Hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.782\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.381\u0026ndash;1.606\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of MI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.428\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.157\u0026ndash;5.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.606\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.549\u0026ndash;4.695\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.387\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of CKD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.008\u0026ndash;5.316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSGLT2i(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.133\u0026ndash;0.647\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.095\u0026ndash;0.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCCB (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.618\u0026ndash;2.530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACEI/ARB (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.554\u0026ndash;2.257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBeta blocker(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.565\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.276\u0026ndash;1.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiuretics (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.310\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.584\u0026ndash;2.948\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.450\u0026ndash;3.401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcarbose (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.937\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.345\u0026ndash;2.546\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsprin (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.562\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.280\u0026ndash;1.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClopidogrel (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.424\u0026ndash;1.904\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.780\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTicagrelor (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.294\u0026ndash;1.853\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUric acid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.998\u0026ndash;1.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBNP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.000\u0026minus;1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.000\u0026minus;1.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.970\u0026ndash;1.515\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriglyceride\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.949\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.737\u0026ndash;1.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL-C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.575\u0026ndash;3.744\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.423\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL-C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.865\u0026ndash;1.858\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.919\u0026ndash;1.794\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFasting glucose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.001\u0026ndash;1.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.921\u0026ndash;1.351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHomocysteine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.035\u0026ndash;1.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.010\u0026ndash;1.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLipoprotein(a)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.999\u0026ndash;1.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.546\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.001\u0026ndash;1.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.999\u0026ndash;1.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.003\u0026ndash;1.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.987\u0026ndash;1.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eCCB, calcium channel blockers;Alanine Aminotransferase,ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; ApoAI, apolipoprotein A-I;eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein; LDL-C,low-density lipoprotein; CKD,chronic kidney disease;ALT, Alanine Aminotransferase;AST, Aspartate Aminotransferase;HbA1c, glycated hemoglobin A1c;BNP, brain natriuretic peptide.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn contrast, detailed findings from the multivariate analysis in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e show that certain factors, including age (95% CI: 1.009\u0026ndash;1.109, OR\u0026thinsp;=\u0026thinsp;1.058, P\u0026thinsp;=\u0026thinsp;0.02), b-type natriuretic peptide levels (95% CI: 1.000-1.001, OR\u0026thinsp;=\u0026thinsp;1.001, P\u0026thinsp;=\u0026thinsp;0.004), and homocysteine levels (95% CI: 1.010\u0026ndash;1.098, OR\u0026thinsp;=\u0026thinsp;1.053, P\u0026thinsp;=\u0026thinsp;0.016), correlate with an increased risk of CI-AKI. Conversely, the application of SGLT2 inhibitors is reaffirmed as a protective factor, significantly reducing the risk of CI-AKI, with an OR of 0.242 (95% CI: 0.095\u0026ndash;0.614; p\u0026thinsp;=\u0026thinsp;0.003, detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults of subgroup analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo assess whether CI- AKI risks differ among various patient demographics, subgroup analyses were conducted, as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. These analyses considered multiple variables, including the usage of ACE inhibitors/ARBs, levels of LVEF, age, sex, the use of diuretics, statins, acarbose and uric acid levels. Results demonstrated that subgroups of patients using SGLT2 inhibitors consistently showed a reduced risk of developing CI-AKI compared to those not using these inhibitors. This trend remained stable across all subgroups analyzed.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e subgroup analysis the risk of CI-AKI in patients with diabetes who had undergone CCTA.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubgroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSGLT2i(-)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSGLT2i(+)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP for interaction\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eACEI/ARB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12/79 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3/63 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.28 (0.08\u0026ndash;1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.960\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15/82 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/98 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.29(0.11\u0026ndash;0.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15/67 (22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5/91 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.20 (0.07\u0026ndash;0.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.375\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12/94 (12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/70 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.41 (0.13\u0026ndash;1.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;65years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6/81 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1/72 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.18 (0.02\u0026ndash;1.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.700\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;65years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21/80 (26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/89 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.28 (0.12\u0026ndash;0.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexy group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11/52 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5/58 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.35 (0.11\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16/109 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/103 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.23 (0.88\u0026minus;0.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUric acid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;378.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15/77 (19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2/84 (2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10 (0.02\u0026ndash;0.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=378.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12/84 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7/77 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.60 (0.22\u0026ndash;1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiuretics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21/141 (14.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/114 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.32 (0.12\u0026ndash;0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.447\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6/20 (30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3/47 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.16 (0.04\u0026ndash;0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27/205(13.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4/79(5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.35(0.12\u0026ndash;1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.756\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4/20(20.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1/18(5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.24(0.02\u0026ndash;2.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.217\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13/49 (26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2/43 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14 (0.03\u0026ndash;0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.202\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14/112 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7/118 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.44 (0.17\u0026ndash;1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcarbose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24/158 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7/117(6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.36(0.15\u0026ndash;0.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.983\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3/3 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2/44(4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00 (0.00-Inf)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of CKD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20/147 (13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7/130 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.36 (0.15\u0026ndash;0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7/14 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2/31 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07 (0.01\u0026ndash;0.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this randomized study, we observed that short-term administration of dapagliflozin significantly reduced the incidence of CI-AKI in diabetic patients undergoing CCTA. Patients receiving SGLT2 inhibition demonstrated more favorable post-procedural renal function trajectories, with lower serum creatinine and higher eGFR values compared with placebo. Importantly, age, BNP, and homocysteine were identified as independent predictors of CI-AKI, emphasizing the multifactorial nature of renal injury in this setting. These results suggest that SGLT2 inhibitors may provide an additional pharmacological option to complement established preventive strategies such as hydration and careful contrast dosing.\u003c/p\u003e\u003cp\u003eCCTA is a contemporary and convenient examination that has been commonly used for detecting coronary atherosclerosis and is increasingly essential for the diagnosis of CHD, risk stratification, and decision-making regarding revascularization\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. However, any repetitive use of CCTA must be approached with special caution because this examination requires the use of a relatively high dose of iodine-containing contrast media\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In addition, some patients are required to undergo subsequent diagnostic coronary angiography and/or therapeutic coronary angioplasty, which raises concerns about additional exposure to contrast media\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Thus, the early method to protect renal function from deterioration prior to this examination is important.\u003c/p\u003e\u003cp\u003eDiabetes mellitus is well established as a major risk factor for CI-AKI,even in patient with preserved renal function\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Paolisso observed a slightly higher overall AKI incidence in diabetes patients without CKD (7%), with rates up to 17% among those with concomitant CKD\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.Diabetic patients are at increased risk of AKI due to underlying endothelial dysfunction, heightened systemic inflammation, and altered renal hemodynamics associated with both diabetes\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In the realm of cardiac care, for vulnerable individuals, even slight, transient renal injuries induced by contrast can significantly affect renal health\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Previous research indicated that out of 580 sequential patients undergoing CCTA, fifty-seven (9.83%) developed CI-AKI, with diabetic patients constituting 59.3% of these cases\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In the course of our study, we recorded a CI-AKI rate of 11.18%. Notably, the rate of CI-AKI in diabetic patients who were administered SGLT2 inhibitors was observed to be 5.15%. Despite advancements in CCTA protocols to address concerns about radiation, reducing the prevalence of CI-AKI continues to be a significant challenge.\u003c/p\u003e\u003cp\u003eSGLT2 inhibitors enhance renal glucose elimination by preventing its reabsorption in the kidneys, thereby lowering serum glucose levels\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Multiple randomized controlled trials have shown that SGLT2 inhibitors, regardless of diabetes status, significantly decrease the risk of CKD progression or mortality compared to placebo\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. A meta-analysis involving 2,572 diabetic patients who underwent CAG indicated that SGLT2 inhibitors significantly reduce the risk of developing CI-AKI\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. However, variability exists in the type, dosage, and timing of SGLT2 inhibitor administration and the protective results of CI-AKI across different studies\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Hosseini\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e et al found short term (2 days) effects of empagliflozin could reduce the CI-AKI in patients undergoing PCI, and the diabetes participants in the study was relative small (28.1%). Zhao\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e et al also reported dapagliflozin exerted robust cardioprotective effects in patients with T2DM and chronic coronary syndrome undergoing percutaneous coronary intervention, but it did not significantly reduce the risk of CI-AKI. In our study, the including patients were all diagnosed with diabetes, and contrast volume was relative smaller than PCI surgery, that is also the novelty of our study.\u003c/p\u003e\u003cp\u003eRecent studies have shown that within the first 24 hours of using contrast media, direct toxic effects can induce occlusions in the tubular structures of proximal tubule cells and lead to mitochondrial dysfunction\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. SGLT2 inhibitors could induce a rapid decline in eGFR during the early phase in clinical trials, and the protective effect was reversible after SGLT2i withdrawal\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.While the exact mechanisms through which SGLT2 inhibitors shield the kidneys remain partially unclear, Huang X et al demonstrated that dapagliflozin ameliorate CI-AKI through suppression of HIF-1a/HE4/NF-kB signaling in vitro and in vivo, which is the pathway involved in hypoxia-induced injury\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.Canagliflozin potentially promotes renal protection against glycerol-induced acute kidney injury by activating the AMPK/ SIRT1/ FOXO-3a/PGC-1a and Nrf2/HO-1 pathways\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Furthermore, dapagliflozin inhibit sodim reabsorption in the proximal tubule, leads to afferent arteriolar vasoconstriction\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Additionally, SGLT2 inhibitors possess anti-inflammatory, antifibrotic, and antioxidative properties, contributing to their ability to safeguard the kidneys from damage triggered by contrast media\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.However, the mechanism by which short-acting statins exert a protective effect against contrast-induced nephropathy after CCTA still needs further investigation.\u003c/p\u003e\u003cp\u003eRecent developments in risk stratification systems for CI-AKI have included various scoring models such as the CHA2DS2-VASc score, Thrombolysis in Myocardial Infarction risk index, and Mehran's score system\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. However, these scoring systems have primarily been applied to patients undergoing PCI and non-diabetes patients. In the present study, it was observed that elderly individuals, along with those exhibiting elevated BNP level and plasma homocysteine levels, were more susceptible to developing CI-AKI during CCTA in diabetic patients. Previously, plasma homocysteine was not as prominently considered in above mentioned scoring systems. In a study led by Barbieri et al\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e, which included 876 patients with reduced renal function (eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60ml/min) undergoing CAG, a notable correlation was discovered between elevated homocysteine levels and the incidence of CI-AKI. Our results also indicated that homocysteine serves as an independent biomarker for predicting CI-AKI in patients post-CCTA. When considered alongside previous evidence, our results are broadly consistent with recent meta-analyses and registry data showing that SGLT2 inhibitors reduce CI-AKI risk in diabetic patients undergoing coronary angiography or PCI. However, our trial differs in that it specifically evaluated CCTA patients, a population less studied despite growing use of this modality in routine clinical practice. The observed benefit in this setting underscores the potential for expanding renoprotective strategies beyond invasive procedures, thereby improving the safety profile of non-invasive imaging renal microcirculation, all of which amplify the nephrotoxic effects of iodinated contrast.\u003c/p\u003e\u003cp\u003eSeveral limitations must be acknowledged. This was a single-center study with a moderate sample size, which may restrict generalizability. Although we identified BNP and homocysteine as predictors, we did not evaluate additional early biomarkers of renal injury, such as cystatin C or γ-glutamyltranspeptidase (GGT), which could provide further mechanistic insights. Moreover, the study only investigated short-term outcomes; whether peri-procedural use of SGLT2 inhibitors translates into long-term renal and cardiovascular benefits requires confirmation. Future large-scale, multicenter randomized trials are needed to validate these findings, clarify the optimal drug type, dose, and timing, and integrate pharmacological protection into standardized CCTA protocols.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study has established that the short-term use of SGLT2 inhibitors plays a significant role in reducing the incidence of contrast-induced acute kidney injury among diabetic patients who undergo CCTA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOriginal draft -Tian zheng,Qianghui Huang; Data curation- YuXuan Zhong,LiFeng Zhang ,Xiao Huang, Conceptualization- Jianxin Hu, Xiaoshu Cheng;Supervision- Biming Zhan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the dedicated work of all the authors that implemented the intervention and evaluation components of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that we have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe project was supported by funding from the following:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe National Natural Science Foundation of China [82060075]; \u0026nbsp; Jiangxi Provincial Natural Science Foundation [20212BAB216057]；The Second Affiliated Hospital Of NanChang University Funding Program[2022efyC07]；2021 SKY Imaging Research Fund of the Chinese Internatinal Medical Foundatin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Data availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ethe datasets analyzed during the current study are available from the corresponding author, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWininger Kevin L, Carpenter Stefanie.Background and Clinical Implications of CCTA and CT-based Fractional Flow Reserve.RADIOL TECHNOL. 2024-09-01;96(1):25-36.\u003c/li\u003e\n\u003cli\u003eGohmann Robin F, Schug Adrian, Pawelka Konrad,et al.Interrater variability of ML-based CT-FFR during TAVR-planning: influence of image quality and coronary artery calcifications.Front Cardiovasc Med. 2023-01-01;10:1301619.\u003c/li\u003e\n\u003cli\u003eFrydman Shir, Freund Ophir, Katash Haytham Abu,et al. Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors.CLIN CARDIOL. 2024-10-01;47(10):e70002.\u003c/li\u003e\n\u003cli\u003eFraenkel Yedidah, Bogot Naama R, Kuint Ruth Cytter,et al. Post-contrast acute kidney injury in the super-elder patients: a CT-scan perspective.JPN J RADIOL. 2024-09-12.\u003c/li\u003e\n\u003cli\u003eChen Lan, Zhao Junlu, Lu Liyun,et al. Association between normal saline infusion volume in the emergency department and acute kidney injury in heat stroke patients: a multicenter retrospective study.RENAL FAILURE. 2024-12-01;46(1):2294151.\u003c/li\u003e\n\u003cli\u003eWang Heng; Gao, Tingting, Zhang Ruijing,et al. The intellectual base and global trends in contrast-induced acute kidney injury: a bibliometric analysis.RENAL FAILURE. 2023-12-01;45(1):2188967.\u003c/li\u003e\n\u003cli\u003eKilickap Mustafa, Kozluca Volkan,Tan T\u0026uuml;rkan Seda,et al. GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Patients With Versus Without Cardiovascular Disease: A Systematic Review, Meta-analysis, and Trial Sequential Analysis.ANGIOLOGY. 2024-10-01; 75(9): 820-830.\u003c/li\u003e\n\u003cli\u003eStarr Jessica A, Pinner Nathan A. The Impact of SGLT2 Inhibitors on Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.ANN PHARMACOTHER. 2024-05-01;58(5):506-513.\u003c/li\u003e\n\u003cli\u003eMeregildo-Rodriguez Edinson Dante, Asmat-Rubio Martha Genara, V\u0026aacute;squez-Tirado Gustavo Adolfo,et al.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). 2023-01-01;14:1307715.\u003c/li\u003e\n\u003cli\u003ePaolisso Pasquale, Bergamaschi Luca, Cesaro Arturo,et al. Impact of SGLT2-inhibitors on contrast-induced acute kidney injury in diabetic patients with acute myocardial infarction with and without chronic kidney disease: Insight from SGLT2-I AMI PROTECT registry. DIABETES RES CLIN PR. 2023-08-01;202:110766.\u003c/li\u003e\n\u003cli\u003eNozaki Yui O,Fujimoto Shinichiro,Takahashi Daigo,et al. Additional prognostic impact of plaque characterization with on-site CT-derived fractional flow reserve in coronary CT angiography.J CARDIOL. 2024-11-01;84(5):336-341.\u003c/li\u003e\n\u003cli\u003eBelmonte Marta,Paolisso Pasquale, Gallinoro Emanuele,et al. Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA).J CARDIOVASC COMPUT. 2024-10-09.\u003c/li\u003e\n\u003cli\u003eFrydman Shir, Freund Ophir, Katash Haytham Abu,et al. Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors. CLIN CARDIOL. 2024-10-01;47(10):e70002.\u003c/li\u003e\n\u003cli\u003eLee ChengChia, Chan Yi-Ling, Wong Yon-Cheong,et al. Contrast-enhanced CT and Acute Kidney Injury: Risk Stratification by Diabetic Status and Kidney Function. RADIOLOGY. 2023-06-01;307(5):e222321.\u003c/li\u003e\n\u003cli\u003ePaolisso P, Belmonte M, Gallinoro E, et al. Impact of SGLT2-inhibitors on acute kidney injury in diabetic patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Cardiovasc Diabetol. 2025 May 21;24(1):221.\u003c/li\u003e\n\u003cli\u003eLi Y, Ren K. The Mechanism of Contrast-Induced Acute Kidney Injury and Its Association with Diabetes Mellitus.Contrast Media Mol Imaging. 2020 Jun 23;2020:3295176.\u003c/li\u003e\n\u003cli\u003eTang H, Chen H, Li Z, et al.Association between uric acid level and contrast-induced acute kidney injury in patients with type 2 diabetes mellitus after coronary angiography: a retrospective cohort study.BMC Nephrol. 2022 Dec 12;23(1):399. \u003c/li\u003e\n\u003cli\u003ePakfetrat M, Nikoo MH, Malekmakan L,et al. Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes.\u003c/li\u003e\n\u003cli\u003eCheng Chun-Han, Hao Wen-Rui, Cheng Tzu-Hurng,et al. Innovative approaches beyond periprocedural hydration for preventing contrast-induced acute kidney injury.World J Radiol. 2024-09-28;16(9):375-379.\u003c/li\u003e\n\u003cli\u003eIsobe Satoshi, Yamada Takashi,Yuba Miyuki,et al.Relationship between pre-procedural microalbuminuria and renal functional changes after coronary computed tomography in diabetic patients.J CARDIOL. 2017-04-01;69(4):666-670.\u003c/li\u003e\n\u003cli\u003eKoshizaka Masaya,Tatsumi Tomoaki, Kiyonaga Fumiko,et al. Comparison of the Risk of Diabetic Retinopathy Between Sodium-Glucose Cotransporter-2 Inhibitors and Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus in Japan: A Retrospective Analysis of Real-World Data.DIABETES THER. 2024-11-01;15(11):2401-2416.\u003c/li\u003e\n\u003cli\u003eEl Khayari Abdellatif, Hakam Soukaina Miya,et al. New insights into the cardio-renal benefits of SGLT2 inhibitors and the coordinated role of miR-30 family. GENES DIS. 2024-11-01;11(6):101174.\u003c/li\u003e\n\u003cli\u003ePakfetrat M, Nikoo MH, Malekmakan L, et al. Comparison of risk factors for contrast-induced acute kidney injury between patients with and without diabetes.Hemodial Int. 2010 Oct;14(4):387-92. \u003c/li\u003e\n\u003cli\u003eLin Donna Shu-Han, Lee Jen-Kuang, Chen Wen-Jone.Clinical Adverse Events Associated with Sodium-Glucose Cotransporter 2 Inhibitors: A Meta-Analysis Involving 10 Randomized Clinical Trials and 71 553 Individuals.J CLIN ENDOCR METAB. 2021-06-16; 106 (7): 2133-2145.\u003c/li\u003e\n\u003cli\u003eYen Fu-Shun,Hwu Chii-Min, Liu Jia-Sin,et al.Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease.ANN INTERN MED. 2024-06-01;177(6):693-700.\u003c/li\u003e\n\u003cli\u003eHosseini Zeinab Sadat,Jamili Mohammad Javad, Ensan, Behzad,et al.Short-term effects of empagliflozin on preventing contrast induced acute kidney injury in patients undergoing percutaneous coronary intervention, a randomised trial.Sci Rep. 2025-01-31;15 (1): 3940.\u003c/li\u003e\n\u003cli\u003eYen Fu-Shun,Hwu Chii-Min, Liu Jia-Sin,et al. Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease.ANN INTERN MED. 2024-06-01;177(6):693-700.\u003c/li\u003e\n\u003cli\u003eJensen Simon Kok, Heide-J\u0026oslash;rgensen Uffe, Andersen Ina Trolle,et al.#462 Initiation of SGLT2i vs GLP1-RA and incidence of AKI in persons with type 2 diabetes mellitus.NEPHROL DIAL TRANSPL. 2024-05-23;39(Supple1)\u003c/li\u003e\n\u003cli\u003eWang Qian, Yu Jianmin, Deng Weizhu,et al. Influence of sodium/glucose cotransporter-2 inhibitors on the incidence of acute kidney injury: a meta-analysis.Front Pharmacol. 2024-01-01;15:1372421.\u003c/li\u003e\n\u003cli\u003eWang Tiansheng, Ji Dongze, St\u0026uuml;rmer Til,et al. The Effect of Sodium Glucose Cotransporter-2 Inhibitors on Hemoglobin A1c Variability and Acute Kidney Injury: A Causal Mediation Analysis.PHARMACOEPIDEM DR S. 2024-08-01;33(8):e5876.\u003c/li\u003e\n\u003cli\u003eLi Jing, Wang Zhen, Zhang BaiXiang,et al.Predictive value of combining the level of fibrinogen and CHA2DS2-VASC Score for contrast-induced acute kidney injury in patients with acute coronary syndromes undergoing percutaneous coronary intervention.INT UROL NEPHROL. 2022-09-01;54(9):2385-2392.\u003c/li\u003e\n\u003cli\u003eZhu Yinghua,Qiu Hang,Wang Zhen,et al. Predictive value of systemic immune-inflammatory index combined with CHA2DS2-VASC score for contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention.INT UROL NEPHROL. 2023-11-01;55(11):2897-2903.\u003c/li\u003e\n\u003cli\u003eHuang X, Guo X, Yan G,et al. Dapagliflozin Attenuates Contrast-induced Acute Kidney Injury by Regulating the HIF-1\u0026alpha;/HE4/NF-\u0026kappa;B Pathway.J Cardiovasc Pharmacol. 2022 Jun 1;79(6):904-913.\u003c/li\u003e\n\u003cli\u003eBishr A, Atwa AM, El-Mokadem BM, El-Din MN. Canagliflozin potentially promotes renal protection against glycerol-induced acute kidney injury by activating the AMPK/SIRT1/FOXO-3a/PGC-1\u0026alpha; and Nrf2/HO-1 pathways. Naunyn Schmiedebergs Arch Pharmacol. 2025 Apr 21. doi: 10.1007/s00210-025-04017-x. Epub ahead of print. PMID: 40257493.\u003c/li\u003e\n\u003cli\u003eGholam MF, Liu LP, Searcy LA, et al.Dapagliflozin Treatment Augments Bioactive Phosphatidylethanolamine Concentrations in Kidney Cortex Membrane Fractions of Hypertensive Diabetic db/db Mice and Alters the Density of Lipid Rafts in Mouse Proximal Tubule Cells.Int J Mol Sci. 2023 Jan 11;24(2):1408.\u003c/li\u003e\n\u003cli\u003eHan JX, Luo LL, Wang YC, et al.SGLT2 inhibitor empagliflozin promotes revascularization in diabetic mouse hindlimb ischemia by inhibiting ferroptosis.Acta Pharmacol Sin. 2023 Jun;44(6):1161-1174. \u003c/li\u003e\n\u003cli\u003eZhu Y, Qiu H, Wang Z, et al. Predictive value of systemic immune-inflammatory index combined with CHA2DS2-VASC score for contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Int Urol Nephrol. 2023 Nov;55(11):2897-2903.\u003c/li\u003e\n\u003cli\u003eMo Changhua, Ma Xiao, Jian Wen, et al.High mobility group box 1 and homocysteine as preprocedural predictors for contrast-induced acute kidney injury after percutaneous coronary artery intervention.INT UROL NEPHROL. 2022-07-01;54(7):1663-1671.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"SGLT2 Inhibitors, Contrast induced acute kidney injury, Diabetic Patients, Coronary computed tomographic angiography, homocysteine","lastPublishedDoi":"10.21203/rs.3.rs-7694999/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7694999/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Notably, SGLT2 inhibitors are renowned for their renal protective properties. However, empirical evidence regarding their efficacy in mitigating CI-AKI risk during Coronary computed tomographic angiography(CCTA) in diabetic cohorts remains scarce.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This research conducted a double blind randomized clinical trial involving 352 patients undergoing CCTA. Participants were randomly assigned to receive SGLT2i (treatment group) or a placebo（control group）, starting 3 days before CCTA. The patients’ serum creatinine levels were evaluated at before and after the procedure. Univariate and multivariate logistic regression analyses were performed to assess the associations of demographic, clinical, and procedural characteristics with CI-AKI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Finally, 161 patients entered each group, two groups patients had no significant demographic and clinical data differences before CCTA. We showed that the incidence of CI- AKI was meaningfully lower in the treatment group (5.15%) than in the control group (13.88%, P = 0.024).Univariate and multivariate regression analysis showed that SGLT2i significantly lowered the rate of CI-AKI [odds ratio(OR)=0.242], increasing Age (OR=1.070), high BNP level (OR=1.001), and high homocysteine values (OR=1.053) were positively correlated with CI- AKI (all p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Observations obtained from this investigation indicate that the use of SGLT2 inhibitors could be protective against the occurrence of CI-AKI in diabetic patients undergoing CCTA.\u003c/p\u003e","manuscriptTitle":"The Effect of short-term SGLT2 Inhibitors therapy on the Development of Contrast-induced acute kidney injury in Diabetic Patients undergoing Coronary computed tomographic angiography：a prospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 16:31:58","doi":"10.21203/rs.3.rs-7694999/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0df782b1-f1f2-4d4c-ac74-8fe5103482c9","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"20591791215015830570721586694709360579","date":"2026-05-25T16:28:46+00:00","index":13,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T16:31:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 16:31:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7694999","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7694999","identity":"rs-7694999","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}