TOPLINE:

Preoperative use of sodium-glucose cotransporter 2 (SGLT2) inhibitors reduced the risk for acute kidney injury (AKI) by 31% after surgery, according to this retrospective, case-control study.

METHODOLOGY:

• Case reports and small retrospective studies have suggested an increased risk for postoperative euglycemic ketoacidosis and AKI in patients using SGLT2 inhibitors preoperatively; however, the actual risks for these conditions are not well understood.
• Researchers conducted a retrospective case-control study using data from the Veterans Affairs Health Care System National Registry (2014-2022) to evaluate risks for postoperative euglycemic ketoacidosis, AKI, and mortality within 30 days after surgery in 7439 preoperative SGLT2 inhibitor users (mean age, 67.7 years; 96.7% men) and 33,489 propensity-matched nonusers (mean age, 67.9 years; 96.4% men).
• Long-term use of preoperative SGLT2 inhibitors was defined as having three or more fills of outpatient prescription within 3 months prior to surgery or less than a 180-day gap since the most recent fill according to pharmacy registries.
• The duration of SGLT2 inhibitor suspension prior to the surgical procedures was not available for this cohort.
• The primary outcome was postoperative euglycemic ketoacidosis; secondary outcomes were postoperative AKI and 30-day in-hospital mortality.

TAKEAWAY:

• Preoperative SGLT2 inhibitor users had reduced risks for AKI (odds ratio [OR], 0.69; 95% CI, 0.62-0.78) and 30-day mortality (OR, 0.70; 95% CI, 0.55-0.88) after surgery but had a modestly increased risk for postoperative euglycemic ketoacidosis (OR, 1.11; 95% CI, 1.05-1.17).
• The renal protective effects of SGLT2 inhibitors were not seen in patients who underwent cardiac surgery or emergency procedures but were observed in those who underwent noncardiac surgery (OR, 0.63; 95% CI, 0.56-0.71) and nonemergency procedures (OR, 0.64; 95% CI, 0.56-0.72).
• The increased risk for postoperative euglycemic ketoacidosis among SGLT2 inhibitor users was most prominent in those who underwent cardiac surgery (OR, 1.30; 95% CI, 1.11-1.54), whereas the greatest mortality benefits were observed in patients who underwent emergency surgery (OR, 0.49; 95% CI, 0.26-0.93).

IN PRACTICE:

“Renoprotective effects of SGLT2i [SGLT2 inhibitor] in the perioperative setting could have far-reaching implications given the annual volume of patients undergoing surgical procedures and the burden of postoperative AKI,” the authors concluded.

SOURCE:

This study was led by Roberta Teixeira Tallarico, MD, Department of Anesthesia and Perioperative Care, University of California San Francisco. It was published online in JAMA Surgery.

LIMITATIONS:

The observational nature of this study limited the ability to establish direct causality. The exact timing of the last SGLT2 inhibitor administration before surgery was unknown, and the absence of ketone measurements limited their diagnostic criteria for euglycemic ketoacidosis. The study population primarily consisted of White male veterans older than 60 years, which limited the generalizability of the results.

DISCLOSURES:

This study was supported by the National Institute of General Medical Sciences of the National Institutes of Health, the statistical core of the University of California San Francisco (UCSF) Pepper Center through the National Institutes of Health, the UCSF FAST-CaR Seed Research Grant, and UCSF Anesthesia Research. Some authors reported receiving grants and personal fees from and having other ties with certain institutions and pharmaceutical companies including the funding sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.