https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Gießen und Marburg GmbH Klinik für Herz-, Kinderherz- und Gefäßchirurgie Gießen, Deutschland; 2Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland
Currently, no approved pharmacological tool prevents acute kidney injury after heart surgery with extracorporeal circulation (ECC). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) show nephroprotective effects in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease (CKD), but their role in cardiac surgery is unclear. Currently, it is recommended to stop SGLT2i at least two days before surgery.
Methods
For this single-centre, a retrospective study including 500 patients undergoing heart surgery between march 2022 and december 2023 was screened, of whom 53 received SGLT2i therapy in addition to standard medical treatment for HF with mildly reduced or preserved LVEF (>40%) at the time of hospital admission for surgery. Within this cohort, we performed 1:1 covariate-adjustment, resulting in 33 patients with SGLT2i treatment and 33 matched controls. The primary endpoint was change in postoperative estimated glomerular filtration rate (eGFR) at day seven after surgery, which was the primary outcome. Secondary outcomes were cumulative urine output, diuretic efficacy and albuminuria over seven days.
Results
Mean baseline eGFR was similar in both groups, with 86.3±14.5 in SGLT2i vs 86.2±13.2 mL/min per 1·73 m² in the control group, p=0.973. Compared with the control group, postoperative eGFR was significantly better in the SGLT2i group by a mean difference (MD) of 11.8 mL/min (95% CI 3.12 to 20.44; p=0.009) within 36 hours postoperatively. The difference in mean albuminuria change from baseline between the two groups was -18.1 mg/ml (95% CI -42.5 to 6.33; p=0.143) in favour of the SGLT2i group. There was a trend toward positive changes in urine output and diuretics efficiency in the SGLT2i group without significant difference, respectively MD 131.4 mL/24h (95% CI -366.7 to 629.5; p=0.600) and MD 11.3 mL/mg (95% CI -12.2 to 34.7; p=0.301), although diuretics administration was higher in control group, respectively 30.6±43.7 vs 51.3±130.1 mg/24h; p=0.268. The need for norepinephrine support was significantly higher in the SGLT2i group compared with the control group, with a mean difference of 8512.2µg/kg (95% CI 429.0 to 16595; p=0.039). The two treatments were also similar in the need for postoperative hemodialysis (1 person in each group). No ketoacidosis or hypoglycaemic events were reported, and no deaths occurred.
Conclusion
SGLT2 inhibitors might have potential nephroprotective effects when undergoing heart surgery with ECC. More evidence is needed regarding the impact of these drugs on patients undergoing cardiac surgery, including those with markedly reduced renal function and ejection fraction.