Starting dapagliflozin one day before elective cardiac surgery reduced the incidence of postoperative acute kidney injury (AKI) during the first seven days after surgery, according to results from the double-blind, placebo-controlled MERCURI-2 trial published July 30 in JAMA.

Conducted at seven centers in the Netherlands, the randomized trial enrolled adults undergoing elective cardiac surgery from June 8, 2023, to Jan. 27, 2025; final follow-up occurred May 16, 2025.

Maartina J. P. Oosterom-Eijmael, MD, et al., randomized 784 patients 1:1 to once-daily dapagliflozin 10 mg orally or placebo, starting the day before surgery and continuing through postoperative day 2, for a total of four doses. Median age was 68 years, 76% were male and nearly all were White; median BMI was 27 kg/m², and median estimated glomerular filtration rate was 80 mL/min/1.73 m².

Randomization was stratified by sex, type 2 diabetes status and study site.

The primary outcome was the between-group difference in AKI during the first seven postoperative days. AKI was defined using Kidney Disease: Improving Global Outcomes criteria as any of the following: a serum creatinine increase of at least 0.3 mg/dL (26.5 µmol/L) within 48 hours after surgery, a 1.5-fold creatinine increase within seven days of surgery, or urine output <0.5 mL/kg/h for six to 12 hours.

Compared with placebo, dapagliflozin significantly reduced AKI over the postoperative follow-up period (28% vs. 52%; relative risk, 0.54; p<0.001).

Dapagliflozin did not improve any secondary outcomes. Atrial fibrillation (AFib) and reoperation were the most frequent adverse events; AFib occurred in 45% of patients in both groups, while reoperation occurred in 11% of the dapagliflozin group and 10% of the placebo group.

"These results were consistent with those of the pilot study, in which perioperative empagliflozin was associated with a lower incidence of AKI after cardiac surgery," write Oosterom-Eijmael and colleagues, adding that the study design "could be easily implemented in clinical practice."

In an accompanying editorial, Wolfgang C. Winkelmayer, MD, MPH, ScD, and Glenn M. Chertow, MD, MPH, write that it will be "important to establish evidence on any longer-term benefits on kidney function, such as chronic kidney disease incidence and progression, from perioperative SGLT2 inhibitor treatment."