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Background <p>Cardiac-surgery-associated acute kidney injury (CSA-AKI) occurs in 20–30% of patients undergoing valve surgery or CABG and is linked to prolonged ICU stay, increased costs, and higher mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially for diabetes, confer cardiovascular and renal protection. We conducted the first meta-analysis to evaluate perioperative SGLT2i use in cardiac surgery patients.</p> Methods <p>Randomized controlled trials and observational studies evaluating SGLT2i in cardiac surgery patients were identified through comprehensive database searches to July 2025. Risk of bias was assessed with RoB 2.0 and the Newcastle–Ottawa Scale. Pooled effect estimates were calculated as risk ratios (RR) with 95% confidence intervals using Mantel–Haenszel random-effects models. Heterogeneity was quantified with I², with prespecified subgroup and sensitivity analyses performed.</p> Results <p>Perioperative SGLT2i use significantly reduced acute kidney injury (RR 0.39, 95% CI 0.29–0.53; I²=1%). Secondary outcomes showed reduced heart failure hospitalization (RR 0.49, 95% CI 0.36–0.67; I²=0%) and major adverse cardiovascular events (RR 0.64, 95% CI 0.48–0.85; I²=50%). A reduction in mortality was observed (RR 0.51, 95% CI 0.30–0.86; I²=47%), although this effect was primarily driven by observational studies and not confirmed in randomized trials. No significant differences were observed for stroke, myocardial infarction, hypoglycaemia, or urinary tract infection.</p> Conclusion <p>Perioperative SGLT2 inhibitor use was associated with improved renal and cardiovascular outcomes after cardiac surgery. While a mortality benefit was suggested, it was not confirmed in randomized trials. Larger, high-quality RCTs are required to establish definitive efficacy and guide perioperative use.</p>

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Perioperative and Long-Term Cardiorenal Outcomes of SGLT2 Inhibitors in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年3月20日

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  • Najaf Ahmed Rajpar,
  • Shehdev Meghwar,
  • Rayyan Nabi,
  • Sanya Ashraf Khaskheli,
  • Sameen Khan,
  • Aamna Rehman,
  • Marhaba Fatima,
  • Sabahat Ul Ain Munir Abbasi,
  • Nafhat Shaikh,
  • Zahid Nabi,
  • Saeed Ahmed,
  • Raheel Ahmed

摘要

Background

Cardiac-surgery-associated acute kidney injury (CSA-AKI) occurs in 20–30% of patients undergoing valve surgery or CABG and is linked to prolonged ICU stay, increased costs, and higher mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially for diabetes, confer cardiovascular and renal protection. We conducted the first meta-analysis to evaluate perioperative SGLT2i use in cardiac surgery patients.

Methods

Randomized controlled trials and observational studies evaluating SGLT2i in cardiac surgery patients were identified through comprehensive database searches to July 2025. Risk of bias was assessed with RoB 2.0 and the Newcastle–Ottawa Scale. Pooled effect estimates were calculated as risk ratios (RR) with 95% confidence intervals using Mantel–Haenszel random-effects models. Heterogeneity was quantified with I², with prespecified subgroup and sensitivity analyses performed.

Results

Perioperative SGLT2i use significantly reduced acute kidney injury (RR 0.39, 95% CI 0.29–0.53; I²=1%). Secondary outcomes showed reduced heart failure hospitalization (RR 0.49, 95% CI 0.36–0.67; I²=0%) and major adverse cardiovascular events (RR 0.64, 95% CI 0.48–0.85; I²=50%). A reduction in mortality was observed (RR 0.51, 95% CI 0.30–0.86; I²=47%), although this effect was primarily driven by observational studies and not confirmed in randomized trials. No significant differences were observed for stroke, myocardial infarction, hypoglycaemia, or urinary tract infection.

Conclusion

Perioperative SGLT2 inhibitor use was associated with improved renal and cardiovascular outcomes after cardiac surgery. While a mortality benefit was suggested, it was not confirmed in randomized trials. Larger, high-quality RCTs are required to establish definitive efficacy and guide perioperative use.