FF97 MERCURI-2, Can a Flozin prevent AKI?

Bypass surgery continues to be the laboratory where we test the most innovative ideas on the prevention of AKI

The Filtrate

Joel Topf @kidney_boy

Swapnil Hiremath @hswapnil.medsky.social

Vipin Varghese

Sophia Ambruso

Special Guests

Rahul Ganatra Deputy Editor NEJM Clinician. https://clinician.nejm.org/editors/AU3406

Jay Koyner Professor of Medicine, University of Chicago. https://www.uchicagomedicine.org/find-a-physician/physician/jay-koyner

Editing

Vipin Varghese

The Kidney Connection written and performed by Timothy Yau

Show Notes

Back to the Future: https://youtu.be/BDuZqYeNiOA?is=r-RE2DgIDBazRAlW

Amino Acids for AKI: The PROTECTION Study NephJC: Trial by Combat: Do Amino Acids provide PROTECTION to the Kidneys?

In 2016 the FDA posted a warning that SGLT2i could induce AKI. This Nature Reviews Nephrology explores possible mechanisms for the AKI: Acute kidney injury from SGLT2 inhibitors: potential mechanisms https://www.nature.com/articles/nrneph.2016.159

But by 2019 the SMART-C Collaboration was looking at the risk of AKI in the large RCTs and found Flozins to be protective: SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30256-6/abstract

If you are actually looking for the best data you should look at the updated meta-analysis from 2025 which extends the findings to patients with and without diabetes and to patients with and without CKD: SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria https://pmc.ncbi.nlm.nih.gov/articles/PMC12595549/

2012 KDIGO AKI Guidelines: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf

The 2025/2026 AKI Draft guidelines: https://kdigo.org/wp-content/uploads/2026/03/KDIGO-2026-AKI-AKD-Guideline-Public-Review-Draft-March-2026.pdf

Meta-analysis of frusemide to prevent or treat acute renal failure https://www.bmj.com/content/early/2005/12/31/bmj.38902.605347.7C

Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition https://diabetesjournals.org/care/article-abstract/38/9/1687/37246/Euglycemic-Diabetic-Ketoacidosis-A-Potential

Topic of this podcast, the MERCURI-2 trial: Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery https://jamanetwork.com/journals/jama/article-abstract/2852324 | NephJC: Too sweet to be true? Prophylactic SGLT2 inhibitors before cardiac surgery https://www.nephjc.com/news/2026/8/18/mercuri2

MERCURI-1 Pilot trial is described here. Looks like it was only published as a pre-print. The first link provides a glimpse at MERCURI-3
https://abrahamhulst.com/research/mercuri-1/

https://www.medrxiv.org/content/10.1101/2024.03.27.24304998v1.full.pdf

Vipin Varghese used to believe in the urinalysis: Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury https://pubmed.ncbi.nlm.nih.gov/35373012/

MERCURI-2 in ClinicalsTrials.gov: proMoting Effective Renoprotection in Cardiac sURgery Patients by Inhibition of SGLT-2 (MERCURI-2)   https://clinicaltrials.gov/study/NCT05590143

Roger Rodby’s 4 favortite equations in Nephrology from Channel Your Enthusioasm: https://pca.st/episode/abff985f-6a87-41f9-bcc9-80b8a85c2441?t=3257.0

IDEAL ICU Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis https://www.nejm.org/doi/full/10.1056/NEJMoa1803213?referrer=https%3A%2F%2Fwww.google.com%2F

Rethinking the definition of oliguria: Identification of an optimal threshold to define oliguria in critically ill patients: an observational study https://pubmed.ncbi.nlm.nih.gov/37254158/

Editorial on MERCURI-2 in JAMA by Wolfgang Winkelmayer and  Glenn Chertow https://jamanetwork.com/journals/jama/fullarticle/2852331

Tubular Secretion

Swapnil Spider Noire Amazon Prime

Sophia Bernadoodle via Starlight Bernadoodle https://starlightbernedoodles.com

Rahul Derry Girls on Netflix

Vipin Tennis Cincinnati Open and the US Open. The death of the one handed backhand.

Jay Slow Horses on Apple TV and Adults on Hulu

Joel Silo season three. Mountain biking.