Dapagliflozin May Reduce AKI Risk After Cardiac Surgery, Suggests Study
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2026-08-18 15:45 GMT | Update On 2026-08-18 15:45 GMT
Australia: Researchers have found in a target trial emulation study that preoperative use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) was associated with a significantly lower risk of postoperative acute kidney injury (AKI) in patients with type 2 diabetes undergoing surgery. Postoperative AKI occurred less frequently among preoperative SGLT2i users, while the findings remained consistent across subgroup and sensitivity analyses.
The study, published in Diabetes, Obesity and Metabolism, was conducted by Frank M. Gao, MBBS(Hons), Department of Endocrinology, Austin Hospital, Melbourne, Victoria, Australia, and colleagues.
SGLT2 inhibitors are widely used to improve glycemic control and reduce cardiovascular and renal complications in people with type 2 diabetes. However, their use around the time of surgery has raised clinical concerns because of potential perioperative complications. The researchers therefore investigated whether taking an SGLT2 inhibitor before surgery was associated with postoperative AKI.
The investigators used routinely collected clinical data from a tertiary hospital in Australia and applied a target trial emulation approach with inverse probability of treatment weighting. Adults with type 2 diabetes who underwent surgery under general anesthesia were compared according to whether they were receiving an SGLT2 inhibitor before surgery.
The primary outcome was AKI occurring within seven days after the procedure.
A total of 2,499 patients were included, of whom 738 were taking an SGLT2 inhibitor before surgery and 1,761 were not. More than half of the participants underwent emergency surgery.
Key findings included:
- Postoperative AKI occurred in 18.6% of patients using SGLT2 inhibitors before surgery.
- AKI occurred in 25.8% of patients who were not taking SGLT2 inhibitors preoperatively.
- Preoperative SGLT2 inhibitor use was associated with 29% lower odds of postoperative AKI (adjusted OR, 0.71; 95% CI, 0.56–0.91; P=0.007).
- The association remained consistent across subgroup and sensitivity analyses.
The researchers acknowledged several limitations. Although the causal inference approach accounted for measured confounding, unmeasured factors could still have influenced the results. The retrospective design also meant that postoperative creatinine testing was not performed at standardized intervals. The study was conducted at a single tertiary hospital, which may limit generalizability to other healthcare settings.
Additionally, the researchers could not determine when SGLT2 inhibitor therapy had been initiated or precisely how long treatment was withheld before surgery. Because the analysis included patients with type 2 diabetes who were already receiving glucose-lowering medication, the findings may not apply to all surgical populations.
The authors concluded that preoperative SGLT2 inhibitor use was associated with lower odds of postoperative AKI among patients with type 2 diabetes undergoing surgery. They emphasized that larger randomized studies are needed to confirm the potential protective effect and better define the perioperative role of SGLT2 inhibitors.
Reference:
Gao FM, Kishore K, Pandey D, Jahanabadi H, Stevens M, Lecamwasam A, Churilov L, Ekinci EI. Effect of preoperative SGLT2 inhibitor use on postoperative acute kidney injury in patients with type 2 diabetes undergoing surgery: A causal inference study using routinely collected data. Diabetes Obes Metab. 2026 Apr;28(4):3193-3201. doi: 10.1111/dom.70509. Epub 2026 Jan 29. PMID: 41607303; PMCID: PMC12992174.
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