Effects of GLP-1 receptor agonists on the incidence of contrast-induced acute kidney injury in patients with Type 2 diabetes mellitus undergoing coronary interventions

Abstract

Background: Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of coronary angiography and percutaneous coronary intervention (PCI), particularly in patients with type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may exert renoprotective effects, but evidence in the setting of contrast exposure remains limited. Objective: To evaluate the association between GLP-1 RA therapy and CI-AKI in patients with T2DM undergoing coronary angiography or PCI for acute coronary syndromes. Methods: This retrospective cohort study included 336 patients with T2DM who underwent coronary angiography or PCI between May 2023 and March 2025. Patients receiving stable GLP-1 RA therapy (n=149) were compared with non-users (n=187). Serum creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline and 48-72 hours after the procedure. CI-AKI was defined as a serum creatinine increase of >= 0.5 mg/dL or >= 25% from baseline within 72 hours. Multivariable logistic regression was used to identify independent predictors of CI-AKI. Results: CI-AKI occurred less frequently among GLP-1 RA users than non-users (8.7% vs 25.7%, p<0.001). At 48-72 hours, eGFR was higher in the GLP-1 RA group (67.1 +/- 12.1 vs 58.0 +/- 11.8 mL/min/1.73 m & sup2;, p<0.001), whereas serum creatinine did not differ significantly (1.02 +/- 0.73 vs 1.17 +/- 1.57 mg/dL, p=0.084). GLP-1 RA use was independently associated with lower odds of CI-AKI (OR 0.290, 95% CI 0.119-0.708; p=0.007). Increasing age (OR 1.332, 95% CI 1.214-1.462; p<0.001) and ST-segment elevation myocardial infarction (OR 5.039, 95% CI 2.368-10.722; p<0.001) were associated with higher odds, whereas higher baseline eGFR was associated with lower odds (OR 0.919, 95% CI 0.862-0.979; p=0.009). Conclusion: GLP-1 RA therapy was independently associated with a lower risk of CI-AKI in patients with T2DM undergoing contrast-based coronary procedures. These findings suggest a potential renoprotective association but require confirmation in prospective multicenter studies.