Facing cardiac surgery? You might be surprised to learn that up to 50% of patients experience acute kidney injury (AKI) afterward. It's a significant concern, and, as Dr. Maartina Oosterom-Eijmael and her team at Amsterdam UMC Locatie AMC point out, effective preventative measures have been surprisingly scarce. But there's a promising development!
Previous research hinted at a connection between sodium-glucose cotransporter-2 (SGLT2) inhibitors and a reduced risk of AKI. Specifically, studies showed a 0.66 hazard ratio (with a 95% confidence interval between 0.55 and 0.80) for a lower incidence of AKI in patients using these inhibitors.
At the American Society of Nephrology Kidney Week in 2025, researchers presented findings from a groundbreaking trial. The study, known as MERCURI-2 (proMoting Effective Renoprotection in Cardiac Surgery Patients by Inhibition of SGLT2), aimed to determine if the SGLT2 inhibitor dapagliflozin could lower the chances of developing postoperative AKI in individuals undergoing cardiac surgery.
The study involved a multicenter, triple-blinded, placebo-controlled, randomized trial. This means neither the patients, the doctors administering the treatment, nor the researchers analyzing the data knew who was receiving the actual medication and who was getting a placebo. This helps eliminate bias and ensures the results are as accurate as possible.
Participants, all adults scheduled for elective cardiac surgery, were randomly assigned to one of two groups. One group received 10 mg of oral dapagliflozin daily, starting the day before surgery and continuing until two days after. The other group received a matching placebo. The main focus was on the difference in AKI incidence between the two groups, using the Kidney Disease: Improving Global Outcomes criteria for diagnosis. They also looked at the different stages of AKI.
The results were compelling. Between June 2023 and May 2025, 784 patients were included in the analysis. The average age was 67 years, 76% of the participants were male, and the average BMI was 27.2 kg/m². Notably, 12% of the participants had type 2 diabetes.
The findings revealed a significant reduction in AKI incidence in the dapagliflozin group compared to the placebo group: 28% versus 53%, a substantial absolute difference of 25% (P<0.001).
Looking at the different stages of AKI, the dapagliflozin group showed the following: 23% (n=89) had stage 1 AKI, 4% (n=16) had stage 2, and 0.8% (n=3) had stage 3. The placebo group saw these numbers: 40% (n=156) with stage 1 AKI, 13% (n=49) with stage 2, and 0.3% (n=1) with stage 3 (P<0.001, P<0.001, and P=0.317, respectively).
In conclusion, the researchers confirmed that perioperative SGLT2 inhibition can indeed help prevent AKI linked to cardiac surgery.
But here's where it gets controversial... Could this become standard practice? Are there potential downsides to SGLT2 inhibitors in this context that need further exploration? What are your thoughts on this study's implications for patients undergoing cardiac surgery? Share your opinions in the comments below!
