Dapagliflozin Makes Good on Preventing Cardiac Surgery-Associated AKI

A Dutch clinical trial found that administering an SGLT2 inhibitor, dapagliflozin, one day before elective cardiac surgery significantly reduced the incidence of acute kidney injury (AKI) at one week post-surgery. The study, published in JAMA, involved 784 adults and showed that those given dapagliflozin had a 54% lower risk of developing AKI compared to those given a placebo (OR 0.36, 95% CI 0.27-0.48).

The most common side effects were atrial fibrillation and reoperation, occurring in 45% and 11% of the dapagliflozin group, respectively.

However, the study's authors and JAMA editors raised concerns about the plausibility of such a large primary treatment effect. They suggested that larger studies with more diverse populations might be needed to confirm these results. Despite this skepticism, the potential benefits of dapagliflozin in preventing postoperative AKI appear promising, particularly given that current guidelines recommend against withholding SGLT2 inhibitors before surgery due to the low risk of euglycemic diabetic ketoacidosis.

These inhibitors are already approved for various indications, including chronic kidney disease and heart failure, making them a valuable option in perioperative care. Further research is needed to fully understand the mechanisms behind SGLT2 inhibitors' kidney-protecting effects and to explore their long-term benefits in patients with diabetes, heart failure, and chronic kidney disease undergoing cardiac surgery.