Safety and outcomes of dapagliflozin initiation in critically ill patients with acute kidney injury: A post-hoc analysis of the defender trial.
J Crit CareJul 31, 2026 (epub)
Fernando G Zampieri, Sean M Bagshaw, Marcelo Costa Batista et al.
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In 30 seconds
This post-hoc analysis of the DEFENDER trial evaluated the safety and outcomes of dapagliflozin in 212 critically ill patients with acute kidney injury (AKI). The study found no significant differences in 28-day mortality (38% vs 40%), kidney replacement therapy (12% vs 18%), or composite outcomes between dapagliflozin and control groups, suggesting that dapagliflozin initiation does not lead to increased harm.
Key findings
- 28-day mortality was 38% in the dapagliflozin group compared to 40% in the control group.
- Kidney replacement therapy was required in 12% of patients receiving dapagliflozin versus 18% in controls.
- The adjusted risk difference for mortality was -1.9% (95% CI -14.5 to 10.7).
- Physiological trajectories showed no significant instability over the first five days.
Why it matters
Understanding the safety profile of SGLT2 inhibitors like dapagliflozin in critically ill patients with AKI is crucial, as it informs clinicians about potential risks and benefits in this vulnerable population.