Abstract: FR-PO0099
Long-Term Clinical Impact of Cardiac Surgery-Associated AKI in Patients with Stage 3 or 4 CKD: LOTUS Study
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Wang, Yan, Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, United States
- Teman, Nicholas, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado, United States
- Jeha, Thaina, Alexion Pharmaceuticals, Barcelona, Spain
- Odo, Nnaemeka U, Optum Inc, Eden Prairie, Minnesota, United States
- Veeranki, Phani, Optum Inc, Eden Prairie, Minnesota, United States
- Solinsky, Christine M., Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, United States
- Nassar, Tareq Issa, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Background
Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI), and major adverse kidney events (MAKE) are serious surgical complications leading to poor clinical outcomes, including need for kidney replacement therapy (KRT), progression to ESKD, and mortality. Limited data is available on long-term (LT) outcomes, notably in patients (pts) with stage 3 or 4 CKD (CKD3/4). This study evaluated LT clinical impacts of CSA-AKI in pts with CKD3/4.
Methods
This retrospective cohort study was conducted using Optum Market Clarity Integrated Clinical dataset. Adults with CKD3/4 who underwent major cardiac surgery (CS) i.e. valve replacement/repair; multivessel coronary artery bypass graft (CABG); or combination of valve surgery and CABG; with cardiopulmonary bypass (CPB) from Jul 2016-Dec 2022 were included. Pts were grouped based on the occurrence of CSA-AKI post-surgery. Outcomes (length of stay [LOS]; MAKE at day 90 [MAKE90: ≥25% decline in eGFR or KRT initiation or death]; CKD progression) were summarized descriptively and compared after matching variables such as age, comorbidities, and surgery by propensity score match (PSM) for CSA-AKI and non-CSA-AKI groups.
Results
In pre-PSM pts, 56.2% (2667/4750) developed CSA-AKI; of which, majority had stage 1 AKI (79.3%). Post PSM, CSA-AKI group was associated with significantly longer inpatient LOS post-surgery (mean: 12.4 vs 9.2 days; p<.001). MAKE90 occurred significantly more often in CSA-AKI pts than non-CSA-AKI (53.2% [470/884] vs 29.1% [200/688], p<.0001). Within 5 yrs, CSA-AKI was associated with a higher percentage decline in eGFR; increase in mortality rate; more rapid CKD3 to 4 progression (all p<.001) and CKD4 to ESKD (p=.003; Fig. 1).
Conclusion
CSA-AKI was prevalent among pts with CKD3/4 undergoing CPB and was associated with significantly longer LOS, worse short and LT mortality and renal outcomes compared with pts without CSA-AKI.
Funding
- Commercial Support – Alexion, AstraZeneca Rare Disease, Boston, MA, United States