Research ArticleResearchMedication SafetyWorkflow

Four perioperative dapagliflozin doses reduced AKI after elective cardiac surgery

JAMA (PubMed)Jul 30, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A double-blind randomized trial of 784 adults undergoing elective cardiac surgery found postoperative acute kidney injury in 28% of patients assigned perioperative dapagliflozin and 52% assigned placebo over seven days.

What NurseJet pulled from the source

At seven Dutch hospitals, participants received dapagliflozin 10 mg or placebo once daily from the day before surgery through postoperative day two. The relative risk of acute kidney injury was 0.54. Atrial fibrillation occurred in 45% of each group, and reoperation occurred in 11% versus 10%.

Why this matters for nurses

Cardiac and perioperative nurses monitor urine output, renal laboratory trends, hemodynamics, and medication holds around surgery. The result may inform protocol review, but it does not establish independent nursing authority to start or continue an SGLT2 inhibitor perioperatively.

Bedside takeaway

Four perioperative dapagliflozin doses reduced seven-day AKI after elective cardiac surgery in one multicenter trial.

How This Applies in Practice

Use this when: Caring for an adult undergoing elective cardiac surgery under a clinician-directed perioperative medication pathway.

On your shift

Verify the ordered dapagliflozin schedule, last dose, diabetes plan, fasting status, and documented perioperative medication holds.
Trend ordered urine output, creatinine, hemodynamics, and metabolic findings and escalate clinically important changes.
Reconcile discharge medications and reinforce the prescribed restart plan and follow-up using teach-back.

Keep in mind: The trial tested one defined four-dose regimen and does not authorize independent initiation or continuation. Follow the cardiac-surgery protocol, facility policy, and provider orders.

Key takeaways

The multicenter trial randomized 392 adults to dapagliflozin and 392 to placebo around elective cardiac surgery.
Acute kidney injury occurred in 28% with dapagliflozin and 52% with placebo during seven-day follow-up.
Atrial fibrillation occurred in 45% of both groups, while reoperation occurred in 11% and 10%, respectively.
The tested regimen comprised four 10-mg doses beginning one day before surgery.

Practice implications

When caring for a patient on a clinician-directed perioperative dapagliflozin pathway, verify the exact schedule, monitor ordered renal and hemodynamic measures, and escalate oliguria, worsening kidney function, hypotension, or medication discrepancies. Follow the approved fasting, diabetes, and perioperative medication protocol.

Limitations & cautions

Follow-up for the primary outcome was seven days, 97% of participants were White, and the study was conducted at seven hospitals in the Netherlands. The abstract reports selected adverse events and does not establish longer-term renal, metabolic, or mortality outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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JAMA (PubMed)

JAMA (PubMed). Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42530910/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Renal failure (PubMed)Sep 7, 2026Research Article

A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

Telemetry Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Journal of neurology (PubMed)Sep 6, 2026Systematic Review

A cumulative meta-analysis found longer survival over time in Duchenne muscular dystrophy, alongside a shift from predominantly respiratory toward cardiac causes of death.

Peds ICUAI summaryReview source

Systematic ReviewResearchPatient EducationAI summary · original source linked below

The review included 53 studies and more than 13,000 patients. Pooled median survival was 29 years among ventilated patients and 19 years among non-ventilated patients, but these study-level observational comparisons do not establish that ventilation alone caused the difference.

Key takeaways

Sixty percent of patients in the included studies received home mechanical ventilation.
Survival improved progressively over time in both ventilated and non-ventilated groups.
As respiratory survival improved, cardiac and other causes accounted for a larger share of deaths.

Why this matters on shift

Patients living longer with Duchenne muscular dystrophy may need sustained respiratory support plus ongoing cardiac and multisystem surveillance across care transitions.

Bedside takeaway

Verify each patient's established respiratory and cardiac plan during admissions and care transitions.

Nursing implications

During admissions and handoffs, verify the established ventilation, airway-clearance, and cardiac-monitoring plan and coordinate concerns with the multidisciplinary team.

Limitations & cautions

Abstract-only summary. This was a study-level meta-analysis of heterogeneous observational survival reports; the ventilated and non-ventilated groups were not randomized, so associations should not be interpreted as treatment effects.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of neurology (PubMed). Improving survival in Duchenne muscular dystrophy across eras: a systematic review and cumulative meta-analysis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

Targeted vitamin D did not significantly reduce major cardiovascular events after MI

Duchenne survival has improved as respiratory and cardiac care evolved