Preoperative Exposure to Sodium-Glucose Cotransporter-2 Inhibitors and Acute Kidney Injury After Cardiac Surgery: A...

This study aims to investigate the impact of preoperative sodium-glucose cotransporter 2 inhibitor (SGLT2i) exposure on cardiac surgery-associated acute kidney injury. This is a single-centre retrospective cohort study with a propensity score weighting analysis for causal inference. The study was set in a cardiovascular and thoracic centre of a teaching hospital (France), between January 2022 and February 2024.

Participants were adults who had undergone cardiac surgery with cardiopulmonary bypass and had ≥1 of the following indications for long-term treatment with SGLT2i: type 2 diabetes with high cardiovascular risk; heart failure with a left ventricular ejection fraction <50%; chronic kidney disease with a glomerular filtration rate <60 mL/min/1.73 m². Preoperative long-term SGLT2i medication versus no preoperative long-term SGLT2i medication, whether or not the treatment was discontinued during the preoperative period.

The primary end point was cardiac-associated acute kidney injury Stage ≥1 in the 7 days after surgery as defined by the creatinine variation (Kidney Disease: Improving Global Outcomes criteria). Causal inference analysis was performed with overlap weighting propensity score analysis. A total 509 patients were included (117 with preoperative exposure to SGLT2i, 65 patients without preoperative treatment discontinuation). Preoperative exposure to SGLT2i was not associated with a significant reduction in cardiac surgery-associated acute kidney injury (35% vs 30%, relative risk 1.12; 95% confidence interval 0.80-1.55).

Preoperative exposure to SGLT2i was not associated with a reduction in cardiac surgery-associated acute kidney injury in the present study, which was underpowered to rule out a potential clinically significant effect.