Impact of SGLT2 Inhibitors Use on Risk of Postoperative Acute Kidney Injury Following Metabolic and Bariatric Surgery: A Retrospective Study.

BACKGROUND: This study investigated whether preoperative use of sodium-glucose cotransporter 2 inhibitors (SGLT2is), known for their cardio-renal benefits in type 2 diabetes (T2DM), reduces postoperative acute kidney injury (AKI) after metabolic and bariatric surgery (MBS). METHODS: The TriNetX research network was used to analyze propensity-matched patients with T2DM who underwent MBS between 2010 and 2024. We compared patients who received SGLT2is (discontinued ≥ 1 week before surgery) with those using other antidiabetic medications. The primary outcome was AKI within 30 days after surgery. Secondary outcomes included risks of mortality, intensive care unit (ICU) admission, acute myocardial infarction/stroke, eGFR decline to < 60 mL/min/1.73 m2, and ketoacidosis. RESULTS: After matching, 4364 patients were included (n = 2182 for each group). The incidence of AKI was identical between the groups (1.88% in both, OR 1.00, 95% CI 0.65-1.55, P = 1.00). No significant differences were observed in mortality, ICU admission, acute myocardial infarction/stroke, eGFR decline to < 60 mL/min/1.73 m2, or ketoacidosis at 30-day follow-up. Subgroup analyses based on baseline CKD status, empagliflozin use, and diabetes duration largely supported the robustness of the findings. Notably, among patients with diabetes duration > 1 year, SGLT2is use was significantly associated with a lower risk of eGFR decline to < 60 mL/min/1.73 m2 (17.7% vs. 21.2%; OR 0.80, 95% CI 0.65-0.97; P = 0.024). CONCLUSIONS: Preoperative SGLT2is use in patients undergoing MBS is associated with a reduced risk of GFR decline in those with longer-duration diabetes, suggesting potential renoprotective benefits. No increased risk of adverse outcomes was observed when these medications were discontinued ≥ 1 week before surgery.