Dapagliflozin Prevents Kidney Injury in Heart Surgery

Postoperative acute kidney injury remains a significant challenge following elective cardiac procedures. Consequently, researchers evaluated whether dapagliflozin acute kidney injury risk could be reduced in adult surgical candidates. The trial compared short-term perioperative dapagliflozin against placebo in patients undergoing elective cardiac surgery.

Dapagliflozin Acute Kidney Injury Prevention: Trial Design and Results

The double-blind randomized clinical trial enrolled 784 adult patients across seven academic and nonacademic medical centers in the Netherlands. Specifically, participants received either 10 mg of oral dapagliflozin or a matching placebo once daily. The treatment started one day prior to surgery and continued through the second postoperative day for a total of four doses. Furthermore, follow-up testing assessed kidney function over seven postoperative days using standard KDIGO criteria.

Overall, 778 participants completed full follow-up testing. Dapagliflozin significantly reduced the overall incidence of postoperative acute kidney injury compared to placebo (28% vs 52%). Additionally, the relative risk was 0.54, demonstrating a strong protective effect. Therefore, perioperative administration of dapagliflozin provides a substantial clinical benefit in reducing surgical renal complications.

Clinical Implications and Mechanism of Action

Cardiopulmonary bypass and surgical stress often induce ischemia, oxidative damage, and systemic inflammation. However, sodium-glucose cotransporter-2 inhibitors offer cellular renal protection through hemodynamic and anti-inflammatory pathways. In addition, acute administration preserves tubular cell integrity during ischemia-reperfusion stress. Consequently, short-term preoperative initiation represents a practical strategy for surgical risk mitigation. Clinicians can integrate these findings into perioperative cardiac care pathways.

Frequently Asked Questions

Q1: How did dapagliflozin reduce acute kidney injury in the trial?

Dapagliflozin reduced acute kidney injury incidence from 52% in the placebo group to 28% in the treatment group, yielding a relative risk of 0.54 over seven postoperative days.

Q2: What was the dosing schedule used for dapagliflozin in this study?

Patients received 10 mg of oral dapagliflozin once daily starting one day prior to elective cardiac surgery and continuing through the second postoperative day, totaling four doses.

Q3: How was acute kidney injury defined in the trial?

Acute kidney injury was defined according to KDIGO criteria, including serum creatinine elevation of at least 0.3 mg/dL within 48 hours, a 1.5-fold creatinine rise within 7 days, or oliguria under 0.5 mL/kg/h for 6 to 12 hours.

References

1. Oosterom-Eijmael MJP et al. Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial. JAMA. 2026 Jul 30. doi: 10.1001/jama.2026.9268. PMID: 42530910.
2. Snel LIP et al. SGLT2 inhibition reduces cardiac surgery-associated acute kidney injury: An open-label randomized study. medRxiv. 2024.
3. Kyushu University Study Group. Acute Dapagliflozin Administration Ameliorates Cardiac Surgery-Associated Acute Kidney Injury in a Rabbit Model. Circ J. 2024; 88: 1488–1498.