Perioperative Dapagliflozin Reduces Acute Kidney Injury After Elective Cardiac Surgery: Study
Netherlands: Researchers have found in new research that among patients undergoing elective cardiac surgery, a short perioperative course of dapagliflozin significantly reduced the incidence of acute kidney injury (AKI) during the first 7 postoperative days. The regimen consisted of four doses of dapagliflozin, starting one day before surgery. These findings, published in JAMA, support the use of perioperative dapagliflozin as a preventive strategy to lower the risk of postoperative AKI in patients undergoing elective cardiac surgery.
Acute kidney injury is a frequent complication after cardiac surgery, affecting an estimated 2% to 50% of patients and increasing the risk of prolonged hospitalization, kidney failure, and death. Although several preventive approaches have been explored, no medication has been established as a standard strategy to reduce postoperative AKI. To address this unmet need, researchers led by Maartina J. P. Oosterom-Eijmael from the Department of Anesthesiology, Amsterdam University Medical Center, the Netherlands, evaluated whether initiating dapagliflozin before surgery could lower the risk of AKI.
The multicenter, double-blind, placebo-controlled randomized clinical trial enrolled 784 adults undergoing elective cardiac surgery at seven hospitals in the Netherlands between June 2023 and January 2025. Participants were randomly assigned to receive either dapagliflozin 10 mg or placebo once daily, beginning the day before surgery and continuing through the second postoperative day, for a total of four doses.
The primary outcome was the occurrence of AKI during the first seven days after surgery, defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria using changes in serum creatinine levels or urine output.
Key findings from the study include:
- Postoperative AKI occurred in 28% of patients receiving dapagliflozin compared with 52% of those receiving placebo.
- Dapagliflozin reduced the relative risk of AKI by 46% compared with placebo.
- Nearly all participants (99%) completed follow-up assessments.
- The most common adverse events were atrial fibrillation and reoperation, with similar rates observed in both treatment groups.
- No new major safety concerns related to dapagliflozin were identified during the study period.
The researchers noted that a brief four-dose perioperative course of dapagliflozin was sufficient to reduce postoperative AKI significantly.
The study had several limitations. It assessed outcomes only during the first seven postoperative days, was not powered to detect differences in severe AKI, dialysis, death, or long-term kidney outcomes, and did not evaluate kidney biomarkers or tissue samples. The predominantly White, male study population not using SGLT2 inhibitors may also limit the generalizability of the findings.
The researchers concluded that perioperative dapagliflozin may offer a simple strategy to prevent AKI after elective cardiac surgery, but called for further studies to confirm its benefits in broader populations, longer-term outcomes, and with other SGLT2 inhibitors.
Reference:
Oosterom-Eijmael MJP, Hulst AH, de Oliveira NPM, et al. Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial. JAMA. Published online July 30, 2026. doi:10.1001/jama.2026.9268
Next Story