ScholarWorks@성균관대학교

초록

Introduction: Despite concerns about the potential of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) to cause acute kidney injury (AKI), recent studies have shown that patients with diabetes on long-term SGLT-2i have lower rates of AKI-related hospitalizations and dialysis. We aimed to assess the real-world preventive effects of SGLT-2i on the risk of postoperative AKI. Methods: We conducted a retrospective study on patients with diabetes who underwent a major surgery at a tertiary hospital in Korea from 2013 to 2023 (n = 5527). We compared patients receiving SGLT-2i with those receiving dipeptidyl peptidase-4 inhibitors (DPP-4i) before surgery to evaluate the development of AKI within 7 days after surgery. A 1:3 propensity score matching was performed to adjust for 10 potential confounders. Results: Before matching, the mean age was 67.5 years, with males comprising 66.3% of the cohort. In the matched cohort, the incidence of postoperative AKI was 11.9% in patients on SGLT-2i and 15.1% in those on DPP-4i (P = 0.026). In a multivariable logistic regression analysis adjusted for various risk factors, the use of SGLT-2i was associated with a 31% reduction in the risk of postoperative AKI (odds ratio [OR]: 0.699; 95% confidence interval [CI]: 0.528–0.918; P = 0.011). Subgroup analyses demonstrated a significant protective effect of SGLT-2i in high-risk populations, particularly in patients with heart failure undergoing cardiovascular surgery, where the incidence of AKI increased to 54%, in which SGLT-2i reduced the risk of AKI by up to 57% (OR: 0.431; 95% CI: 0.205–0.889; P = 0.024). However, the SGLT-2i group experienced a higher incidence of mild diabetic ketoacidosis (DKA) than the DPP-4i group (0.8% vs. 0%; P < 0.001). Conclusion: The use of SGLT-2i was independently associated with a lower risk of postoperative AKI than the use of DPP-4i in patients with type 2 diabetes, particularly in high-risk groups such as those with heart failure undergoing cardiovascular surgery. These findings suggest that SGLT-2i may have a role in perioperative AKI prevention in patients with diabetes, although careful monitoring for DKA is advised. © 2025

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