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Thorac Cardiovasc Surg
DOI: 10.1055/a-2616-4962
Original Cardiovascular

Impact of SGLT2 Inhibitor Therapy on Patients Undergoing Cardiac Surgery

Zulfugar T. Taghiyev 
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Lili-Marie Beier
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Carina Leweling
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Sophia Gunkel
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Kevin Mike Sadowski
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Birgit Assmus
2   Department of Cardiology, University Hospital Giessen, Giessen, Hessen, Germany
,
Andreas Boening
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
› Author Affiliations
Funding This research made use of data collected from the mesenteric ischemia registry, which was supported by the Clinician Scientist Program of Justus-Liebig-University (JLU-CAREER), funded by the German Research Council (DFG, GEPRIS project: 413584448).
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Abstract

Background

Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are nephroprotective in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease, but their potential influence during cardiac surgery is unclear. Currently, discontinuation of SGLT2i at least 2 days before surgery is recommended.

Methods

Between March 2022 and December 2023, 53 cardiac surgical patients on SGLT2i therapy in addition to standard medical treatment for HF were compared with 447 other HF patients from the same period. After 1:1 covariate adjustment, 33 patients with SGLT2i treatment were matched with 33 controls. The primary endpoint was a change in estimated glomerular filtration rate (eGFR) 36 hours after surgery. Secondary endpoints were changes in eGFR, cumulative urine output, diuretic efficacy, and albuminuria over seven postoperative days.

Results

Mean baseline eGFR was similar between the groups (p = 0.973). Thirty-six hours postoperatively, eGFR was significantly higher in the SGLT2i group by a mean difference (MD) of 11.8 mL/min (95% CI [3.12–20.44]; p = 0.009) compared with the control group. The mean urinary albumin level was 18.1 mg/mL lower in the SGLT2i group (95% CI [−42.5–6.33]; p = 0.143). There were numerically positive changes in urine output and diuretic efficacy in the SGLT2i group without significant difference: MD 131.4 mL/24 hours (95% CI [−366.7–629.5]; p = 0.600) and MD 11.3 mL/mg (95% CI [−12.2–34.7]; p = 0.301), respectively, although the dosage of diuretics was higher in controls (30.6 ± 43.7 vs. 51.3 ± 130.1 mg/24 hours; p = 0.268, respectively).

Conclusion

SGLT2i may have nephroprotective effects in patients undergoing heart surgery with extracorporeal circulation. More evidence is needed to determine whether SGTL2i needs to be discontinued before surgery.

Keywords

SGLT2i - renal failure - kidney injury - cardiac surgery

Note

The manuscript was presented as a talk at the DGK Annual Meeting in Hamburg, Germany, on September 27, 2024.


Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.


Authors' Contributions

Z.T.T contributed to conceptualization; data collection and curation; investigation; methodology; supervision; validation; visualization; formal analysis; writing—original draft. L-M.B., C.L., M.S. and S.G. contributed to data collection, validation, and curation. B.A. contributed to supervision; conceptualization; writing—review and editing. A.B. contributed to administration; supervision; data curation and validation; review, and editing.




Publication History

Received: 04 March 2025

Accepted: 19 May 2025

Accepted Manuscript online:
20 May 2025

Article published online:
05 June 2025

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