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Lookup NU author(s): Dr Raheel Ahmed
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© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.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.
Author(s): Rajpar NA, Meghwar S, Nabi R, Khaskheli SA, Khan S, Rehman A, Fatima M, Abbasi SUAM, Shaikh N, Nabi Z, Ahmed S, Ahmed R
Publication type: Article
Publication status: Published
Journal: Cardiovascular Drugs and Therapy
Year: 2026
Pages: Epub ahead of print
Online publication date: 20/03/2026
Acceptance date: 19/01/2026
ISSN (print): 0920-3206
ISSN (electronic): 1573-7241
Publisher: Springer
URL: https://doi.org/10.1007/s10557-026-07848-9
DOI: 10.1007/s10557-026-07848-9
PubMed id: 41860647
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