One-third of diabetic patients exhibit impaired kidney function and low Glomerular Filtration Rate (GFR). Diabetics hospitalized for ACS are likely to undergo cardiac catheterization using IV contrast. Contrast-induced acute kidney injury is defined by absolute (0.5 mg/dL) or relative increase (25%) in serum creatinine (SCr) 48-72 hours after contrast administration. Cessation of Metformin is recommended 48 hours prior to catheterization, placing patients at risk for Hyperglycemia.
Vildagliptin, an oral anti-diabetic drug of the DPP-4 inhibitor class, provides glycemic control in patients with T2DM and CKD.
We assessed Vildagliptin for glycemic control in 58 T2DM adult patients naïve to DPP4 Inhibitors upon admission to ICCU with ACS diagnosis, while monitoring kidney function tests.
Metformin was discontinued during hospitalization and patients divided into two groups in a randomized controlled manner. Control group received SC Insulin injections to control blood glucose values below 140 mg/dl or 180 mg/dl postprandial. Study group received SC Insulin and Vildagliptin with the same target.
GFR > 50 ml/min patients received Vildagliptin 50mg x 2/day; GFR < 50 ml/min received 1/day.
Creatinine values were measured and GFR calculated (MDRD GFR Equation) on admission (before cardiac catheterization), on discharge and 30 days after discharge.
Data were documented: creatinine values, urea values, and calculated GFR.
The two groups differed in GFR change between admission and discharge (F(1,46)=3.16, p=0.08). The mean±SD values of GFR in controls declined significantly (t(22)=1.94, p=0.06) from admission 77.6±30.5 ml/min to discharge 70.9±23.8 ml/min vs. Study group, changed (t(24)=0.53, p=0.60) from 69.72±20.6 ml/min to 71.4±27.3 ml/min.
Administration of Vildagliptin to diabetics hospitalized for ACS, even with cardiac catheterization, did not impair kidney function or lead to Acute Renal Failure (ARF). There was no deterioration in kidney function 30 days after discharge.
