GLP-1 receptor agonist use and contrast-associated acute kidney injury after contrast-enhanced CT and CT angiography in adults with type 2 diabetes and chronic kidney disease: a propensity score-matched cohort study

AIMS: To examine whether glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with contrast-associated acute kidney injury (CA-AKI) after contrast-enhanced computed tomography (CE-CT) or computed tomographic angiography (CTA) in adults with type 2 diabetes and chronic kidney disease (CKD). METHODS: We conducted a TriNetX retrospective cohort study of adults with type 2 diabetes and CKD who underwent CE-CT or CTA from January 2020 to January 2025. GLP-1 RA use was defined by a prescription within six months before imaging. The primary outcome was a new acute kidney injury diagnosis within three days. Separate 1:1 propensity score-matched analyses were conducted for CE-CT and CTA, with eGFR-stratified and sensitivity analyses. RESULTS: After matching, the CE-CT and CTA cohorts included 6,995 and 3,285 pairs, respectively. CA-AKI occurred in 3.8% of GLP-1 RA users versus 4.5% of non-users after CE-CT (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.71-0.99) and in 4.5% versus 6.1% after CTA (OR 0.74, 95% CI 0.59-0.92). The absolute risk differences were 0.7% points and 1.5% points, respectively. HbA1c remained imbalanced after matching. Negative-control outcomes were null, and eGFR-stratified associations were inconsistent between cohorts. CONCLUSIONS: GLP-1 RA use was associated with a lower observed risk of CA-AKI after CE-CT and CTA in adults with type 2 diabetes and CKD. Residual HbA1c imbalance and the observational design limit causal interpretation; prospective studies using creatinine-based outcomes are needed.