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All Journal Jurnal Kedokteran Syiah Kuala Jurnal Ilmiah Mahasiswa Kedokteran Medisia Archives of The Medicine and Case Reports Journal of Medical Science; Jurnal Ilmu Medis Rumah Sakit Umum Daerah dr. Zainoel Abidin, Banda Aceh JKKI : Jurnal Kedokteran dan Kesehatan Indonesia Jurnal Penyakit Dalam Indonesia
Desi Salwani, Desi
Fakultas Kedokteran Universitas Syiah Kuala/RSUD Dr. Zainoel Abidin
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Perioperative Safety and Outcomes of SGLT2 Inhibitors in Diabetic Kidney Disease Patients Undergoing Non-Cardiac Surgery: A Meta-Analysis of Euglycemic Ketoacidosis and Acute Kidney Injury Risks Rizki Jaya Amal; Abdullah; Maimun Syukri; Desi Salwani
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.861

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have revolutionized the management of diabetic kidney disease (DKD), offering profound renoprotection through the restoration of tubuloglomerular feedback and reduction of intraglomerular pressure. However, their perioperative safety profile remains a subject of intense debate. While the pharmacological mechanisms of SGLT2 inhibitors may theoretically ameliorate ischemia-reperfusion injury and prevent acute kidney injury (AKI), the metabolic shift towards ketogenesis raises concerns regarding perioperative Euglycemic Diabetic Ketoacidosis (euDKA). This meta-analysis aimed to quantify the risks of AKI and euDKA in DKD patients continuing or withholding SGLT2i prior to non-cardiac surgery. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. We analyzed data from seven high-quality studies, including large-scale propensity-matched cohorts and randomized controlled trials published through 2026, involving patients with type 2 diabetes mellitus (T2DM) and DKD undergoing non-cardiac surgery. The primary outcomes were the incidence of postoperative AKI (KDIGO criteria) and euDKA. Secondary outcomes included 30-day mortality and urinary tract infections. Pooled Odds Ratios (OR) with 95% Confidence Intervals (CI) were calculated using a random-effects model (DerSimonian-Laird). The pooled analysis included a total of 142,530 patients. The use of SGLT2 inhibitors was associated with a robust and statistically significant reduction in postoperative AKI compared to non-users (Pooled OR 0.69; 95% CI 0.62–0.78; p < 0.001). This renoprotective signal was consistent across various surgical subtypes. Conversely, SGLT2i use was associated with an increased risk of euDKA (Pooled OR 2.34; 95% CI 1.45–3.78; p = 0.001), although the absolute event rate remained low (<1%). Subgroup analysis revealed that preoperative withdrawal of <24 hours significantly exacerbated DKA risk compared to a withdrawal period of 3–4 days, without providing additional protection against AKI. In conclusion, in patients with DKD undergoing non-cardiac surgery, preoperative SGLT2 inhibitor use presents a distinct renoprotective paradox: it significantly reduces the risk of AKI, likely through attenuation of oxidative stress and preservation of renal oxygenation, but increases the risk of euDKA. The benefits of AKI prevention outweigh the rare risk of DKA, provided a structured preoperative withdrawal protocol of 3 days is strictly implemented.
Co-Authors . Andriansjah Abdullah Abdullah Abdullah Abdullah Abdullah Abdullah Abdullah Aida Lydia Alvina Widhani, Alvina Andri Baftahul Khairi Angga Pramudita Dewi Yulianti Prastiwi Erlita, Diana Evy Yunihastuti Farissa Farissa FIRDAUSA, SARAH Hardi Yanis Harimurti, Kuntjro Irsyah, Abid Dhiyauddin Alfani Julia Sari Khairunnisa Khairunnisa Kuntjoro Harimurti Maimun Syukri Maimun Syukri Maimun Syukri Mondrowinduro, Prionggo Muhammad Diah Muhsin Muhsin Nababan, Saut Horas Nasir, Ujainah Zaini Novita Andayani, Novita Praptini, Mirna Nurasri Rizki Jaya Amal Saminan . Teguh Harjono Karjadi, Teguh Harjono Ujainah Zaini Nasir Vera abdullah Yanti, Budi