The effects of sodium-glucose transporter 2 inhibition on cardiac surgery-associated acute kidney injury: An open-label randomized pilot study

作者：Lars I.P. Snel, Maartina J P Oosterom-Eijmael, Elena Rampanelli, Yugeesh R. Lankadeva, Mark Philip Plummer, Benedikt Preckel, Jeroen Hermanides, Daniël H. van Raalte, Abraham H. Hulst · 发表于：Journal of Clinical Anesthesia · 年份：2025 · DOI：10.1016/j.jclinane.2025.111811 · 被引用次数：30 · 研究领域：Acute Kidney Injury Research、Hyperglycemia and glycemic control in critically ill and hospitalized patients、Parathyroid Disorders and Treatments

BACKGROUND: Sodium-glucose transporter-2 (SGLT2) inhibitors reduced the incidence of acute kidney injury in large cardiovascular outcome trials in patients with chronic heart and kidney failure. Acute kidney injury is a common complication following cardiac surgery. We hypothesized that perioperative SGLT2 inhibition could reduce kidney injury after cardiac surgery, measured with the biomarker neutrophil gelatinase-associated (NGAL). METHODS: In this open-label phase IV, randomized, parallel-group, pilot study, adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive either an SGLT2 inhibitor, empagliflozin (10 mg; oral) once daily, from three days before surgery until postoperative day two, or standard-of-care. The primary outcome was the between-group difference of serum NGAL on the second postoperative day. Moreover, other biomarkers for acute kidney injury were measured, including serum kidney injury molecule-1 (KIM-1), hypoxia-inducible factor-1 alpha (HIF-1α), and urine NGAL/Creatinine and KIM-1/Creatinine ratios. Additional outcomes included acute kidney injury incidence within the first seven days following cardiac surgery according to Kidney Disease: Improving Global Outcomes criteria and metabolic parameters, including ketone body concentrations and glycemic control. RESULTS: , empagliflozin n = 25, control n = 30) in the intention-to-treat analysis. There were no significant between-group differences in serum and uri...