{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:38:24Z","timestamp":1791851904106,"version":"4.3.4"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n Two percent to 50% of patients undergoing elective cardiac surgery experience acute kidney injury (AKI) postoperatively. Medications to prevent AKI after elective cardiac surgery have not been identified.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n In patients undergoing elective cardiac surgery, to evaluate whether initiating dapagliflozin 1 day prior to surgery reduces the incidence of AKI at 7 days after cardiac surgery, compared with placebo.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicenter, double-blind, placebo-controlled randomized clinical trial conducted at 2 academic medical centers and 5 nonacademic hospitals in the Netherlands. Eligible participants were adults undergoing elective cardiac surgery. Enrollment occurred between June 8, 2023, and January 27, 2025. Final follow-up occurred May 16, 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients were randomized 1:1 to receive either dapagliflozin (10 mg orally; n\u2009=\u2009392) or placebo once daily (n\u2009=\u2009392), beginning on the day before surgery and continuing through the second postoperative day (total of 4 doses).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n The primary outcome was the between-group difference in AKI (defined as an increase in serum creatinine level by at least 0.3 mg\/dL [26.5 \u00b5mol\/L] within 48 hours after surgery, a 1.5-fold creatinine increase within 7 days of surgery, or urine output less than 0.5 mL\/kg\/h for 6 to 12 hours according to Kidney Disease: Improving Global Outcomes criteria) during the first 7 postoperative days.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 784 participants enrolled, 778 (99%) completed follow-up testing (median age, 68 [61-74] years; 76% male; 97% White; median body mass index, 27 [IQR, 25-30]; and median estimated glomerular filtration rate, 80 [IQR, 67-89] mL\/min\/1.73 m\n 2<\/jats:sup>\n ). Compared with placebo, dapagliflozin reduced the incidence of AKI (28% vs 52%; relative risk, 0.54 [95% CI, 0.45-0.65];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) over 7-day follow-up after surgery. Atrial fibrillation and reoperation were the most frequent adverse events. The incidence of atrial fibrillation was 45% (176\/392) in the dapagliflozin group vs 45% (176\/392) in the placebo group, and the incidence of reoperation was 11% (43\/392) vs 10% (39\/392), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In patients undergoing elective cardiac surgery, 4 doses of dapagliflozin, beginning the day before surgery, reduced the incidence of AKI during the 7-day postoperative period.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05590143<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.9268","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:30:23Z","timestamp":1785425423000},"page":"765","source":"Crossref","is-referenced-by-count":4,"title":["Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery"],"prefix":"10.1001","volume":"336","author":[{"given":"Maartina J. P.","family":"Oosterom-Eijmael","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands"},{"name":"Department of Endocrinology, Amsterdam University Medical Center, Amsterdam, the Netherlands"},{"name":"Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham H.","family":"Hulst","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands"},{"name":"Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson P. 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