How do you integrate perioperative dapagliflozin with hemodynamic optimization and nephrotoxin avoidance for AKI prevention in a patient undergoing elective cardiac surgery?

At this time, I would not recommend perioperative dapagliflozin for the prevention of AKI in patients undergoing elective cardiac surgery. The primary outcome in the MERCURI-2 trial was a composite definition of AKI using the KDIGO criteria which incorporates changes in both serum creatinine and urine output. Post hoc analyses revealed a major discrepancy between creatinine-only AKI and urine output-only AKI. There was no statistical difference between the two groups in terms of creatinine-defined AKI (14% vs 15%). The dapagliflozin group had a significantly lower incidence of oliguria (21% vs. 48%), resulting in a lower incidence of AKI as defined by urine output. However, dapagliflozin itself induces an osmotic diuresis and natriuresis. T...