Facing cardiac surgery? You might be surprised to learn that up to 50% of patients experience acute kidney injury (AKI) afterward. It's a serious complication, and, as Dr. Maartina Oosterom-Eijmael and her team at Amsterdam UMC Locatie AMC point out, effective preventative measures have been surprisingly scarce. But what if there was a way to significantly reduce this risk?
Previous studies have hinted at a connection between certain medications and a lower chance of AKI. Specifically, sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown promise. These drugs have been linked to a 34% reduction in AKI incidence (hazard ratio, 0.66; 95% CI, 0.55-0.80).
At the American Society of Nephrology Kidney Week 2025, researchers presented the results of a groundbreaking study, the proMoting Effective Renoprotection in Cardiac Surgery Patients by Inhibition of SGLT2 (MERCURI-2) trial. This was a multicenter, triple-blinded, placebo-controlled randomized trial designed to investigate whether the SGLT2 inhibitor dapagliflozin could prevent postoperative AKI in patients undergoing cardiac surgery.
The study involved adult patients scheduled for elective cardiac surgery. Participants were randomly assigned to receive either 10 mg of oral dapagliflozin or a matching placebo, taken once daily starting the day before surgery and continuing until two days after. The primary focus was on the difference in AKI incidence between the two groups, using the Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes included the severity stages of AKI.
The study included a total of 784 patients in the intention-to-treat analysis, conducted between June 2023 and May 2025. The patient group was predominantly male (76%), with an average age of 67 years and a mean BMI of 27.2 kg/m2. Around 12% of the participants had type 2 diabetes.
And this is the part most people miss... The results were striking. The dapagliflozin group showed a significant reduction in AKI incidence compared to the placebo group (28% vs. 53%; an absolute difference of 25%, with a P-value of <0.001). This means a substantial number of patients could potentially avoid this serious complication.
Breaking down the AKI stages, in the dapagliflozin group, 23% (n=89) of patients experienced stage 1 AKI, 4% (n=16) had stage 2, and only 0.8% (n=3) reached stage 3. In contrast, the placebo group saw 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).
The researchers concluded that this large trial confirmed that perioperative SGLT2 inhibition can prevent cardiac surgery-associated AKI.
But here's where it gets controversial... Could this become standard practice? What are the potential side effects of SGLT2 inhibitors in this context? Do you think this study will change how cardiac surgery patients are treated? Share your thoughts in the comments below!
