Dapagliflozin initiated 1 day prior to elective cardiac surgery reduced the incidence of acute kidney injury at 7 days compared with placebo (28% vs 52%; RR 0.54; 95% CI 0.45-0.65; P<.001).
RCT (n=784)
Double-blind
1:1
Yes
Does dapagliflozin reduce the incidence of acute kidney injury in adults undergoing elective cardiac surgery?
A short perioperative 4-dose course of dapagliflozin significantly reduced the incidence of acute kidney injury in patients undergoing elective cardiac surgery.
Relative Risk: 0.54 (95% CI 0.45–0.65)
Absolute Event Rate: 28% vs 52%
p-value: p=<.001
Importance: Two percent to 50% of patients undergoing elective cardiac surgery experience acute kidney injury (AKI) postoperatively. Medications to prevent AKI after elective cardiac surgery have not been identified. Objective: In patients undergoing elective cardiac surgery, to evaluate whether initiating dapagliflozin 1 day prior to surgery reduces the incidence of AKI at 7 days after cardiac surgery, compared with placebo. Design, Setting, and Participants: Multicenter, double-blind, placebo-controlled randomized clinical trial conducted at 2 academic medical centers and 5 nonacademic hospitals in the Netherlands. Eligible participants were adults undergoing elective cardiac surgery. Enrollment occurred between June 8, 2023, and January 27, 2025. Final follow-up occurred May 16, 2025. Intervention: Patients were randomized 1:1 to receive either dapagliflozin (10 mg orally; n = 392) or placebo once daily (n = 392), beginning on the day before surgery and continuing through the second postoperative day (total of 4 doses). Main Outcome and Measure: The primary outcome was the between-group difference in AKI (defined as an increase in serum creatinine level by at least 0.3 mg/dL 26.5 µmol/L within 48 hours after surgery, a 1.5-fold creatinine increase within 7 days of surgery, or urine output less than 0.5 mL/kg/h for 6 to 12 hours according to Kidney Disease: Improving Global Outcomes criteria) during the first 7 postoperative days. Results: Of 784 participants enrolled, 778 (99%) completed follow-up testing (median age, 68 61-74 years; 76% male; 97% White; median body mass index, 27 IQR, 25-30; and median estimated glomerular filtration rate, 80 IQR, 67-89 mL/min/1.73 m2). Compared with placebo, dapagliflozin reduced the incidence of AKI (28% vs 52%; relative risk, 0.54 95% CI, 0.45-0.65; P < .001) over 7-day follow-up after surgery. Atrial fibrillation and reoperation were the most frequent adverse events. The incidence of atrial fibrillation was 45% (176/392) in the dapagliflozin group vs 45% (176/392) in the placebo group, and the incidence of reoperation was 11% (43/392) vs 10% (39/392), respectively. Conclusions and Relevance: In patients undergoing elective cardiac surgery, 4 doses of dapagliflozin, beginning the day before surgery, reduced the incidence of AKI during the 7-day postoperative period. Trial Registration: ClinicalTrials.gov Identifier: NCT05590143.
“Hereon, investigators should aim to better understand the mechanism(s) by which SGLT2 inhibitors reduce the risk of AKI among patients undergoing elective cardiac surgery as well as those with type 2 diabetes, heart failure, and chronic kidney disease treated with SGLT2 inhibitors longer-term. Moreover, they should briskly and rigorously conduct randomized, placebo-controlled clinical trials of SGLT2 inhibitors in established AKI, aiming to arrest or attenuate its evolution and/or hasten its recovery.”
The MERCURI-2 trial, published in JAMA, showed that pre-operative dapagliflozin significantly reduces acute kidney injury after cardiac surgery, suggesting a new, simple preventive strategy.
Oosterom-Eijmael et al. (Thu,) conducted a rct in Elective cardiac surgery (n=784). Dapagliflozin vs. Placebo was evaluated on Acute kidney injury (AKI) during the first 7 postoperative days (RR 0.54, 95% CI 0.45-0.65, p=<.001). Dapagliflozin initiated 1 day prior to elective cardiac surgery reduced the incidence of acute kidney injury at 7 days compared with placebo (28% vs 52%; RR 0.54; 95% CI 0.45-0.65; P<.001).