Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial.

Summary

In this multicenter, double-blind randomized trial of 784 adults undergoing elective cardiac surgery, four perioperative doses of dapagliflozin reduced 7-day postoperative AKI from 52% with placebo to 28% with treatment. The relative risk was 0.54, with no difference in atrial fibrillation or reoperation rates between groups.

Key Findings

• AKI occurred in 28% of patients receiving dapagliflozin versus 52% receiving placebo over 7 days.
• The relative risk of postoperative AKI was 0.54 with dapagliflozin, with a 95% confidence interval of 0.45-0.65 and P<0.001.
• Atrial fibrillation occurred in 45% of both groups, and reoperation occurred in 11% versus 10% of the dapagliflozin and placebo groups, respectively.

Clinical Implications

A short perioperative course of dapagliflozin may become a candidate strategy for preventing AKI after elective cardiac surgery. Before routine adoption, clinicians should consider confirmation in broader surgical populations and monitor for volume depletion, ketoacidosis, infection, and perioperative medication-management issues.

Limitations

• The study was conducted in elective cardiac surgery patients in the Netherlands, which may limit generalizability to emergency surgery, other procedures, and more diverse populations.
• Follow-up focused on the first 7 postoperative days, so effects on persistent kidney dysfunction, long-term renal outcomes, and mortality were not established.

Future Directions

Future trials should evaluate long-term renal and cardiovascular outcomes, perioperative safety in patients with reduced kidney function or higher ketoacidosis risk, and effectiveness across different cardiac and noncardiac surgical populations.