Acute kidney injury complicates a large share of elective cardiac surgery and has had no drug shown to prevent it. This double-blind trial at seven Dutch hospitals randomised 784 adults to dapagliflozin 10 mg or placebo, starting the day before surgery and continuing to the second postoperative day, four doses in total.
Acute kidney injury by KDIGO criteria over seven days occurred in 28% on dapagliflozin against 52% on placebo, a relative risk of 0.54 (95% CI 0.45-0.65). Atrial fibrillation was identical at 45% in both arms and reoperation nearly so, at 11% against 10%.
Two things temper immediate adoption. The placebo AKI rate of 52% is at the very top of the reported range, which suggests a sensitive definition and raises the question of how much of the prevented injury was clinically consequential rather than a creatinine rise. And the population was 97% White with a median eGFR of 80, so this is not yet evidence for the frailer, more comorbid patients in whom AKI does the most harm. Even so, a halving from four cheap tablets in a complication with no alternative prophylaxis is a finding to watch closely and to raise with your surgical colleagues.
- AKI at 7 days: 28% with dapagliflozin vs 52% with placebo (RR 0.54)
- Only four doses, starting the day before surgery
- No excess atrial fibrillation or reoperation
- Population 97% White with preserved eGFR; generalisability is untested
The statistics, in plain English
A relative risk of 0.54 with an interval of 0.45 to 0.65 is both large and precise, which is unusual and worth trusting on its own terms. The caution is not statistical but definitional: KDIGO criteria count a creatinine rise of 0.3 mg/dL, so a substantial part of that 52% is biochemical injury that may never have declared itself clinically. A trial reporting dialysis or death would be more persuasive still.
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