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

Inclusion Criteria:

1. Age ≥18 years

2. Undergoing coronary artery bypass graft and/or valve surgery with cardiopulmonarybypass

3. AKI risk score ≥6 at the time of screening

4. Written informed consent from the patient or surrogate

Exclusion Criteria:

1. 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, usemost recent value in last 3 months)

• Urine output ≤0.5 ml/kg/h x 6 consecutive hours (only assessed in patients withhourly monitoring via Foley catheter)

• Receipt of renal replacement therapy (RRT) within 7d

2. Advanced chronic kidney disease (eGFR <15 ml/min/1.73m2 or end-stage kidney diseasereceiving RRT)

3. Hemoglobin <8 g/dL (closest value in the prior 3 months)

4. Fever (temperature ≥38⁰C) in the last 48h

5. Suspected or confirmed bacteremia, endocarditis, or pyelonephritis

6. Pneumonia, aspiration, or bilateral pulmonary infiltrates from an infectiousetiology reported on chest x-ray or CT scan in the last 7d

7. Positive COVID-19 test within previous 10d

8. Chronic iron overload (including conditions such as hemochromatosis and betathalassemia major) or previous iron chelation therapy (including prior participationin DEFEAT-AKI)

9. Known hypersensitivity to deferoxamine

10. Taking prochlorperazine

11. Severe hearing loss

12. Pregnant or breastfeeding

13. Prisoner

14. Concurrent participation in another interventional research study in which theintervention has potential interaction with deferoxamine

15. Surgery to be performed under conditions of circulatory arrest

16. Receiving extracorporeal membrane oxygenation

17. Durable ventricular assist device (VAD) prior to surgery (does not include Impelladevice or intra-aortic balloon pump)

18. Any condition which, in the judgement of the investigator, might increase the riskto the patient

19. Conflict with other research studies