Kidney Week

Abstract: FR-OR106

Deferoxamine for the Prevention of Cardiac Surgery-Associated AKI: The DEFEAT-AKI Randomized Clinical Trial

Session Information

• Late-Breaking Science Orals - 1
  October 25, 2024 | Location: Room 6C, Convention Center
  Abstract Time: 04:30 PM - 04:40 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States

David E. Leaf, MD, MS, MSc, FASN

• Krajewski, Megan L, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Megan L Krajewski, MD

• Kim, Edy Yong, Brigham and Women's Hospital, Boston, Massachusetts, United States

Edy Yong Kim, PhD, MD

• Muehlschlegel, Jochen Daniel, Johns Hopkins University, Baltimore, Maryland, United States

Jochen Daniel Muehlschlegel, MSc, MD, MBA

• Bagchi, Aranya, Massachusetts General Hospital, Boston, Massachusetts, United States

Aranya Bagchi, MD

• Shaefi, Shahzad, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Shahzad Shaefi, MD, MPH

Background

Multiple lines of evidence support a central role of free iron in the pathogenesis of acute kidney injury (AKI). Patients undergoing cardiac surgery may be particularly susceptible to iron-mediated AKI due to the profound hemolysis that occurs from cardiopulmonary bypass and intraoperative transfusion of red blood cells.

Methods

In an NIH-funded, phase II, multicenter, double-blind trial, we randomly assigned adult patients undergoing coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass considered to be at high-risk of AKI to receive a 12-hour IV infusion of deferoxamine (30 mg/kg) or an equal volume of saline placebo beginning immediately after induction of anesthesia. The primary outcome was the occurrence of AKI within 7 days, defined according to the KDIGO consensus criteria, incorporating changes in serum creatinine, urine output, and kidney replacement therapy. Secondary outcomes included AKI stage, receipt of kidney replacement therapy, atrial fibrillation, prolonged receipt of invasive mechanical ventilation, sepsis, and time to liberation from IV vasoactive medications.

Results

We enrolled 301 patients from 3 large academic medical centers in Boston, MA and assigned 151 to deferoxamine and 150 to placebo. AKI occurred in 99 patients (65.6%) in the deferoxamine group and in 108 (72.0%) in the placebo group (relative risk, 0.91; 95% CI, 0.78–1.06). Rates of secondary outcomes were similar between groups (Table), as were rates of adverse events.

Conclusion

Among adult patients undergoing cardiac surgery, prophylactic administration of IV deferoxamine did not reduce the occurrence of AKI.

Funding

• NIDDK Support