Sodium–glucose cotransporter-2 inhibitor use is associated with reduced acute kidney injury after transcatheter aortic valve implantation

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Background Acute kidney injury (AKI) remains a clinically relevant complication after transcatheter aortic valve implantation (TAVI). Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated nephroprotective effects in chronic kidney disease (CKD); however, TAVI-specific data are limited. Methods We analyzed a single-center registry of consecutive patients who underwent transfemoral TAVI for aortic stenosis between January 2015 and December 2025. After exclusions, 532 patients were included (SGLT-2i users, n = 112; non-users, n = 420). The primary endpoint was post-procedural AKI. Secondary outcomes were need for hemodialysis and in-hospital mortality. Propensity score matching (PSM) was performed (1:1), yielding 110 matched pairs. Results In the overall cohort, AKI occurred more frequently in SGLT-2i non-users than users (16.0% vs. 4.5%, p < 0.001), along with a higher requirement for hemodialysis (6.0% vs. 0.9%, p = 0.025). In the CKD subgroup, non-users had higher AKI (35.0% vs. 4.5%, p < 0.001) and hemodialysis rates (15.0% vs. 0.0%, p = 0.005), whereas outcomes were similar in the non-CKD subgroup. In the PSM cohort, non-users had higher AKI (20.0% vs. 4.5%, p < 0.001), hemodialysis (7.3% vs. 0.9%, p = 0.035), and in-hospital mortality (10.0% vs. 1.8%, p = 0.019). In the PSM CKD subgroup, non-users demonstrated markedly higher AKI (43.2% vs. 4.5%, p < 0.001), hemodialysis requirement (13.6% vs. 0.0%, p = 0.026), and in-hospital mortality (20.5% vs. 2.3%, p = 0.015), while non-CKD subgroup showed comparable outcomes. In multivariable analysis, SGLT-2i use independently predicted lower AKI risk in both the overall and matched cohorts. Conclusions SGLT-2i use was associated with reduced AKI after TAVI, particularly in patients with CKD, and remained significant after propensity matching and multivariable adjustment.