Kidney Week

Abstract: TH-PO0751

AKI and Subsequent Major Adverse Kidney Events in Patients with CKD Undergoing Cardiac Surgery

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

• Shelbaya, Khaled, Alexion Pharmaceuticals Inc, Boston, Massachusetts, United States

Khaled Shelbaya, MD, MMSc, MSc

• Farag, Youssef MK, Alexion Pharmaceuticals Inc, Boston, Massachusetts, United States

Youssef MK Farag, MD, PhD, MPH, FASN

• Solinsky, Christine M., Alexion Pharmaceuticals Inc, Boston, Massachusetts, United States

Christine M. Solinsky, MS, PhD

• Williams, Cory, Alexion Pharmaceuticals Inc, Boston, Massachusetts, United States

Cory Williams, MBBS, PhD

• Singh, Ajay K., Alexion Pharmaceuticals Inc, Boston, Massachusetts, United States

Ajay K. Singh, MD

• Zarbock, Alexander, Universitatsklinikum Munster Klinik fur Anasthesiologie Operative Intensivmedizin und Schmerztherapie, Münster, NRW, Germany

Alexander Zarbock, MD

Background

There is limited data on the association between post-cardiac surgery acute kidney injury (CSA-AKI) and the incidence of major adverse kidney events (MAKE) in patients with chronic kidney disease (CKD). A clearer understanding of MAKE epidemiology is essential to inform the design of future clinical trials in CSA-AKI.

Methods

EPIS-AKI is an international, prospective, observational, multi-national cohort study in patients undergoing major surgery. In this analysis, we studied a subgroup of patients who underwent cardiac surgery with cardiopulmonary bypass (CPB). Both creatinine and urine output KDIGO criteria were used to identify AKI incidence and severity. The outcome of interest was MAKE90, defined as a composite of decrease in eGFR from baseline ≥ 25% at day 90, need for renal replacement therapy or death by day 90. Analyses were stratified by CKD severity, with stages 3–4 (eGFR 15–59 mL/min/1.73 m²) compared with stages 1–2 (eGFR ≥ 60mL/min/1.73m²).

Results

Among the overall EPIS-AKI population, 2,954 patients underwent elective CPB surgery; of these, 2,505 had CKD stages 1–2 and 441 (15%) had CKD stages 3–4. The median age of whole study population was 64 years (Q1, Q3: 57, 71), and 29% of participants were female. A greater proportion of CKD Stage 3/4 patients developed CSA-AKI compared to CKD Stage 1/2 (46% vs 22%) (Figure 1). Among patients with an acute kidney injury, severe CSA-AKI (KDIGO Stage 2/3) was more frequent (52%) in CKD Stage 3/4 compared to CKD Stage 1/2 (33%). The incidence of MAKE90 increased with worsening CSA-AKI severity, rising from 26% in KDIGO stage 1 to 45% in KDIGO stages 2–3, however MAKE90 also occurred in the absence of clinically diagnosed CSA-AKI (13%) (Figure 1).

Conclusion

Severe CSA-AKI occurred more frequently among patients with more advanced baseline CKD and carried a higher risk of MAKE90 than non-severe.

Figure 1: Incidence of CSA-AKI and Subsequent MAKE90 in patients with CKD.

Funding

• Commercial Support – Alexion Pharmaceutical