Kidney Week

Abstract: TH-OR012

Hepcidin and Cardiac Surgery-Associated AKI

Session Information

• AKI Across the Care Continuum: From Detection to Recovery
  October 22, 2026 | Location: Room 203, Convention Center
  Abstract Time: 04:50 PM - 05:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Hofmann, Patrick, Division of Nephrology, Mass General Brigham, Boston, Massachusetts, United States

Patrick Hofmann, MD

• Kaunfer, Sarah Allison, Division of Nephrology, Mass General Brigham, Boston, Massachusetts, United States

Sarah Allison Kaunfer

• Rhoge, Mark E., Division of Nephrology, Mass General Brigham, Boston, Massachusetts, United States

Mark E. Rhoge

• Azzi, Jamil R., Division of Nephrology, Mass General Brigham, Boston, Massachusetts, United States

Jamil R. Azzi, MD, PhD

• Shaefi, Shahzad, Department of Anesthesiology, Mass General Brigham, Boston, Massachusetts, United States

Shahzad Shaefi, MD, MPH

• Bagchi, Aranya, Department of Anesthesiology, Mass General Brigham, Boston, Massachusetts, United States

Aranya Bagchi, MD

• Parikh, Chirag R., Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Fox, Amanda A., Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, United States

Amanda A. Fox, MD, MPH

• Body, Simon C., Department of Anesthesiology, Boston University School of Medicine, Boston, Massachusetts, United States

Simon C. Body, MBChB, MPH

• Muehlschlegel, Jochen Daniel, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Jochen Daniel Muehlschlegel, MD, MSc, MBA

• Leaf, David E., Division of Nephrology, Mass General Brigham, Boston, Massachusetts, United States

David E. Leaf, MD, MS, MSc, FASN

Background

Experimental and human studies suggest that iron dysregulation and the hepcidin-ferroportin-iron axis contribute to cardiac surgery–associated AKI (CSA-AKI). Hepcidin is the main regulator of systemic iron homeostasis, and its augmentation has been proposed as a strategy for CSA-AKI prevention. However, whether hepcidin is protective or harmful in this setting remains unclear.

Methods

We conducted a cohort study of 1,777 adults undergoing cardiac surgery at a tertiary care hospital to evaluate the association between preoperative hepcidin and CSA-AKI. Plasma hepcidin and IL-6 were measured preoperatively. Hepcidin was categorized into quartiles, with quartile 1 serving as the reference. The primary outcome was CSA-AKI, defined by KDIGO serum creatinine criteria. Multivariable logistic regression was used to adjust for demographics, comorbidities, laboratory values, surgical characteristics, and IL-6.

Results

CSA-AKI occurred in 397 patients (22.3%). Patients who developed CSA-AKI were older, had higher rates of hypertension, diabetes, chronic kidney disease, and atrial fibrillation, and were more likely to undergo urgent surgery. Higher hepcidin quartiles were monotonically associated with a greater risk of CSA-AKI (odds ratio [OR], 1.72; 95% CI, 1.26–2.36 for highest vs lowest quartile; Figure 1A). This association remained significant after multivariable adjustment, including for IL-6 (OR, 1.57; 95% CI, 1.11–2.22) and was consistent across subgroups (Figure 1B).

Conclusion

Higher preoperative hepcidin concentrations were independently associated with increased CSA-AKI risk, supporting a role for iron regulatory pathways in CSA-AKI pathogenesis.

Acknowledgment

Funding: NIH grant R01DK126685

Funding

• NIDDK Support