Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and serious complication associated with increased morbidity, mortality, and healthcare costs. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), including dapagliflozin and empagliflozin, have shown renoprotective benefits in chronic settings, but their perioperative role in CSA-AKI prevention is not well defined. This study was to map the current literature on the use of SGLT2 inhibitors such as empagliflozin and dapagliflozin for the prevention of CSA-AKI, identify evidence gaps, and inform future research directions. A scoping review was conducted using PubMed, Ovid (MEDLINE/Embase), Cochrane Library, and trial registries from January 2010 to May 2025. Eligible studies included adult cardiac surgery patients receiving SGLT2i therapy in the perioperative period. Data were extracted on study design, SGLT2i agent, timing, AKI definitions, outcomes, and safety reporting. Seven studies met the inclusion criteria, and one early-terminated trial met the inclusion criteria. The terminated study halted recruitment after achieving its predefined outcome and transitioned into a larger multicentre trial. Empagliflozin was the most frequently studied agent, with dapagliflozin included in a smaller subset. Findings suggest a lower incidence of CSA-AKI in patients receiving SGLT2i compared to controls; however, heterogeneity in study design, small sample sizes, and inconsistent safety reporting limit the strength of conclusions. Three ongoing randomized controlled trials were also identified, reflecting growing interest in this therapeutic strategy. Early data suggest that SGLT2 inhibitors may offer renoprotective effects in the cardiac surgical population. Evidence specific to dapagliflozin remains limited. Larger, high-quality RCTs are needed to determine efficacy, safety, and the optimal timing and perioperative use of SGLT2i to prevent CSA-AKI.