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Effect of preoperative SGLT2 inhibitor use on postoperative acute kidney injury in patients with type 2 diabetes

Frank M Gao1,2,3, Kartik Kishore3,4, Dinesh Pandey4

  • 1Department of Endocrinology, Austin Hospital, Melbourne, Victoria, Australia.

Diabetes, Obesity & Metabolism
|January 29, 2026
PubMed
Abstract

Insights

Preoperative use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) significantly lowered the risk of acute kidney injury (AKI) after surgery in patients with type 2 diabetes. This finding highlights SGLT2i as a protective measure for kidney health in surgical patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Surgical Care

Background:

  • Type 2 diabetes increases surgical risk, particularly for acute kidney injury (AKI).
  • Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are increasingly used for diabetes management.
  • The perioperative impact of SGLT2i on AKI risk is an important clinical question.

Purpose of the Study:

  • To evaluate the association between preoperative SGLT2 inhibitor use and the incidence of postoperative AKI.
  • To determine if SGLT2i confers renal protection in patients with type 2 diabetes undergoing surgery.

Main Methods:

  • Target trial emulation using inverse probability of treatment weighting on real-world data.
  • Comparison of patients with type 2 diabetes undergoing surgery, stratified by preoperative SGLT2i use.
  • Primary outcome: postoperative AKI within 7 days of surgery.

Main Results:

  • 2499 patients included; 738 used preoperative SGLT2i.
  • Postoperative AKI occurred in 18.6% of SGLT2i users vs. 25.8% of non-users.
  • Preoperative SGLT2i use was associated with significantly lower odds of AKI (aOR 0.71, P=0.007).

Conclusions:

  • Preoperative SGLT2 inhibitor use is associated with reduced odds of postoperative AKI in patients with type 2 diabetes.
  • Findings suggest a potential renoprotective effect of SGLT2i in the perioperative setting.
  • Results were robust across sensitivity and subgroup analyses.
Keywords:
SGLT2 inhibitorsacute kidney injurysurgerytype 2 diabetes

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