Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: 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.
Source: JAMA
Authors: Maartina J. P. Oosterom-Eijmael, Abraham H. Hulst, Nelson P. Monteiro de Oliveira, Ed D. Niesten, Nicobert E. Wietsma, Bastiaan M. Gerritse, Thierry V. Scohy, Thijs C. D. Rettig, Ferdinand T. F. Snellen, Magiel F. Voogd, Marc B. Godfried, Rients N. de Boer, Jeroen Wink, Lisa M. M. van der Werff, Christa M. Cobbaert, L. Renee Ruhaak, Susanne Eberl, Benedikt Preckel, Markus W. Hollmann, Jimmy Schenk, Jeroen Hermanides, Daniel H. van Raalte, MERCURI-2 Study Group, Tahira El Benhaji, Catherine SC Bouman, Eline F Bruggemans, Naomi Chen, Thomas GV Cherpanath, Giel Cox, Marcel G Dijkgraaf, Nimrat Grewal, Hilde Herrema, Nathalie J Huizing, Yvonne J Jordens, Robert JM Klautz, Lars G Knaap, Wil G Kopatz, Nardo J van der Meer, Marcella CA Müller, Abigail J Murray, Alice C Pap, Frederique Paulus, Gabriela L Pieters, Jorinde AW Polderman, Merlijn Reijrink, Abby Roest, Cato Schmitz, Youri Schut, Lars IP Snel, Nick G Steijn, Ayla Y Stobbe, Hajar Taârnit, Luuk T Tegel, Maaike SY Thio, Divya PR Tika, Martijn Tolsma, Imran Uddin, Denise P Veelo, Michelle Verhagen, Alexander PJ Vlaar, Henrico JFT Wesselink
Institutions: Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Medisch Spectrum Twente, Amphia Ziekenhuis, Isala, Medisch Centrum Leeuwarden, OLVG, Leiden University Medical Center, Amsterdam Public Health
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7171808412