Deferoxamine for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury

Inclusion criteria

• Age ≥18 years
• Undergoing coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass
• AKI risk score ≥6 at the time of screening
• Written informed consent from the patient or surrogate

Exclusion criteria

• AKI, defined as any of the following:

• Increase in serum creatinine ≥0.3 mg/dl in 48h
• Increase in serum creatinine ≥50% in 7d (if no value available in last 7d, use most recent value in last 3 months)
• Urine output ≤0.5 ml/kg/h x 6 consecutive hours (only assessed in patients with hourly monitoring via Foley catheter)
• Receipt of renal replacement therapy (RRT) within 7d
• Advanced chronic kidney disease (eGFR <15 ml/min/1.73m2 or end-stage kidney disease receiving RRT)
• Hemoglobin <8 g/dL (closest value in the prior 3 months)
• Fever (temperature ≥38⁰C) in the last 48h
• Suspected or confirmed bacteremia, endocarditis, or pyelonephritis
• Pneumonia, aspiration, or bilateral pulmonary infiltrates from an infectious etiology reported on chest x-ray or CT scan in the last 7d
• Positive COVID-19 test within previous 10d
• Chronic iron overload (including conditions such as hemochromatosis and beta thalassemia major) or previous iron chelation therapy (including prior participation in DEFEAT-AKI)
• Known hypersensitivity to deferoxamine
• Taking prochlorperazine
• Severe hearing loss
• Pregnant or breastfeeding
• Prisoner
• Concurrent participation in another interventional research study in which the intervention has potential interaction with deferoxamine
• Surgery to be performed under conditions of circulatory arrest
• Receiving extracorporeal membrane oxygenation
• Durable ventricular assist device (VAD) prior to surgery (does not include Impella device or intra-aortic balloon pump)
• Any condition which, in the judgement of the investigator, might increase the risk to the patient
• Conflict with other research studies