The Effect of Continuing Versus Withholding SGLT2 inhibitors on Incidence of Contrast Associated Acute Kidney Injury in Patients Undergoing Coronary Angiography: A Randomized Controlled Trial (BELIEVE Trial).

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors are increasingly recognized as first-line treatments for type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, peri-procedural management of SGLT2 inhibitors in patients undergoing elective coronary angiography (CAG) remains unclear. This study aimed to evaluate the effects of continuing versus withholding SGLT2 inhibitors on the incidence of contrast-associated acute kidney injury (CA-AKI) in patients undergoing elective CAG.

Methods: In this prospective, multicenter, open-label randomized controlled trial, patients who had been using SGLT2 inhibitors for at least three months were randomly assigned to either continue (n = 102) or withhold (n = 98) their SGLT2 inhibitors during the peri-procedural period. In the continuing group, patients maintained their SGLT2 inhibitor regimen uninterrupted, while in the withholding group, patients discontinued SGLT2 inhibitors 72 hours before CAG and resumed them post-procedure. The primary outcome was the incidence of CA-AKI, defined according to the KDIGO criteria. Secondary outcomes included changes in renal function, adverse events during hospitalization, and 90-day clinical outcomes.

Results: The incidence of CA-AKI was comparable between the two groups, occurring in 3.92% (4/102) of patients in the continuing group and 3.06% (3/98) in the withholding group (risk difference: 0.86%; 95% CI: -4.22% to 5.94%; p = 0.74). The change in serum creatinine at 48 hours post-CAG was significantly lower in the continuing group (-0.06 ± 0.15 mg/dL) than in the withholding group (-0.02 ± 0.16 mg/dL), with a mean difference of -0.05 mg/dL (95% CI: -0.09 to -0.004; p = 0.047). One patient in the continuing group developed diabetic ketoacidosis, and no other significant safety concerns were observed.

Conclusions: Among low-risk patients undergoing coronary angiography, contrast-associated AKI was rare, and withholding or continuing SGLT2 inhibitors had no meaningful impact on AKI risk or renal function. Routine discontinuation in this setting may not be necessary.