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Role of Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors in Preventing Cardiac Surgery-Associated Acute Kidney
Hasan Al Chalabi1, Abdousamad Said Omar2, Amy Gordon3
1Emergency Medicine, Aneurin Bevan University Health Board, Cwmbran, GBR.
Abstract:
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and serious complication associated with increased morbidity, mortality, and healthcare costs. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), including dapagliflozin and empagliflozin, have shown renoprotective benefits in chronic settings, but their perioperative role in CSA-AKI prevention is not well defined. This study was to map the current literature on the use of SGLT2 inhibitors such as empagliflozin and dapagliflozin for the prevention of CSA-AKI, identify evidence gaps, and inform future research directions. A scoping review was conducted using PubMed, Ovid (MEDLINE/Embase), Cochrane Library, and trial registries from January 2010 to May 2025. Eligible studies included adult cardiac surgery patients receiving SGLT2i therapy in the perioperative period. Data were extracted on study design, SGLT2i agent, timing, AKI definitions, outcomes, and safety reporting. Seven studies met the inclusion criteria, and one early-terminated trial met the inclusion criteria. The terminated study halted recruitment after achieving its predefined outcome and transitioned into a larger multicentre trial. Empagliflozin was the most frequently studied agent, with dapagliflozin included in a smaller subset. Findings suggest a lower incidence of CSA-AKI in patients receiving SGLT2i compared to controls; however, heterogeneity in study design, small sample sizes, and inconsistent safety reporting limit the strength of conclusions. Three ongoing randomized controlled trials were also identified, reflecting growing interest in this therapeutic strategy. Early data suggest that SGLT2 inhibitors may offer renoprotective effects in the cardiac surgical population. Evidence specific to dapagliflozin remains limited. Larger, high-quality RCTs are needed to determine efficacy, safety, and the optimal timing and perioperative use of SGLT2i to prevent CSA-AKI.
Insights
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) may reduce cardiac surgery-associated acute kidney injury (CSA-AKI). Current evidence is limited by study heterogeneity and small sample sizes, necessitating further research to confirm efficacy and safety.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication with high morbidity, mortality, and costs.
- Sodium-glucose co-transporter 2 inhibitors (SGLT2i) demonstrate renoprotective effects in chronic kidney disease, but their perioperative role in CSA-AKI prevention is unclear.
- Existing literature on SGLT2i for CSA-AKI prevention requires mapping to identify evidence gaps and guide future research.
Purpose of the Study:
- To conduct a scoping review of the current literature on SGLT2 inhibitors (empagliflozin, dapagliflozin) for CSA-AKI prevention.
- To identify evidence gaps and inform future research directions regarding perioperative SGLT2i use in cardiac surgery.
- To assess the preliminary efficacy and safety data of SGLT2i in preventing CSA-AKI.
Main Methods:
- A comprehensive scoping review was performed using major databases (PubMed, Ovid, Cochrane) and trial registries.
- Studies included adult cardiac surgery patients receiving SGLT2i perioperatively, published between January 2010 and May 2025.
- Data extraction focused on study design, SGLT2i agent, timing, AKI definitions, outcomes, and safety reporting.
Main Results:
- Seven studies and one early-terminated trial met inclusion criteria; empagliflozin was the most studied SGLT2 inhibitor.
- Preliminary findings suggest a potential reduction in CSA-AKI incidence with SGLT2i use compared to controls.
- Significant heterogeneity in study design, small sample sizes, and inconsistent safety reporting limit definitive conclusions.
- Three ongoing randomized controlled trials indicate growing interest in this therapeutic area.
Conclusions:
- Early evidence suggests SGLT2 inhibitors may offer renoprotective benefits in the cardiac surgical population.
- Evidence specifically for dapagliflozin in CSA-AKI prevention is currently limited.
- Larger, high-quality randomized controlled trials are essential to establish the efficacy, safety, and optimal perioperative use of SGLT2i for CSA-AKI prevention.
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