Kidney Week

Abstract: TH-PO0750

Clinical Characteristics, Kidney Replacement Therapy Exposure, and Intensive Care Unit Outcomes in Cardiac Surgery-Associated AKI Requiring Kidney Replacement Therapy

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Avdiu, Alban, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Alban Avdiu

• Christ, Micha, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Micha Christ

• Kraft, Leonie, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Leonie Kraft, MD, DrMed

• Oberacker, Tina, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Tina Oberacker

• Schricker, Severin, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Severin Schricker, MD, DrMed

• Fuchs, Moritz, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Moritz Fuchs

• Nico, Schmid, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Schmid Nico

• Goebel, Nora, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Nora Goebel, MD, PhD

• Heyne, Nils, Universitatsklinikum Tubingen, Tübingen, BW, Germany

Nils Heyne, MD

• Latus, Joerg, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Joerg Latus, MD

• Schanz, Moritz, Robert-Bosch-Krankenhaus GmbH, Stuttgart, BW, Germany

Moritz Schanz, DrMed, MBA

Background

Cardiac surgery-associated acute kidney injury (CSA-AKI) requiring kidney replacement therapy (KRT) represents the most severe phenotype of perioperative kidney injury and is associated with substantial morbidity and mortality. Detailed KRT exposure remains limited in contemporary cohorts.

Methods

We conducted a retrospective single-center cohort study of 547 adult patients who developed AKI requiring KRT during intensive care unit (ICU) stay after cardiac surgery from July 2017 to February 2024. Perioperative characteristics, timing and duration of KRT and ICU mortality were analyzed. Multivariable logistic regression models identified factors associated with ICU mortality and prolonged KRT (≥7 days and ≥14 days).

Results

Median age was 71 years (IQR 62–77); 32.0% were female. Pre-existing CKD was present in 30.9%, diabetes in 31.6%, and heart failure in 74.6%. Median time from ICU admission to first AKI stage was 10.3 hours (IQR 7.8–14.4), and to KRT initiation 58.3 hours (IQR 29.5–107.4). ICU mortality was 35.6%. Median KRT duration was 4.0 days (IQR 1.0–12.0); prolonged KRT for ≥7 days and ≥14 days occurred in 38.9% and 20.8% of patients, respectively (Table 1). In multivariable analysis, pre-existing heart failure was independently associated with ICU mortality (OR 1.83, p=0.034). Initial AKI stage 2 (OR 2.99, p=0.038) and longer bypass time (OR 1.009 per minute, p=0.019) were associated with prolonged KRT. Initial AKI stage 3 showed inverse association, possibly reflecting competing mortality risk.

Conclusion

CSA-AKI requiring KRT is characterized by rapid AKI onset and substantial KRT burden. Pre-existing heart failure and prolonged bypass time are key determinants of adverse short-term outcomes. These findings describe the early KRT burden in severe CSA-AKI and support subsequent long-term analyses focusing on dialysis dependence and renal recovery.

Acknowledgment

Generative AI support was used for language editing: ChatGPT.