Loren E. Smith, MD, PhD, associate professor of anesthesia with University of Iowa Health Care, has been awarded a five-year, $2.5 million R01 grant from the National Heart, Lung, and Blood Institute (NHLBI) to lead a major clinical research study investigating the relationship between acute kidney injury (AKI) and delirium following cardiac surgery. Dr. Smith is a nationally recognized investigator whose research focuses on the biological mechanisms underlying postoperative complications and recovery.

Postoperative delirium is a common and serious complication that can prolong hospitalization and adversely affect recovery after cardiac surgery. AKI is one of the strongest known risk factors for delirium, yet the biologic mechanisms linking these conditions remain poorly understood. Smith's newly funded study will test the hypothesis that AKI and delirium may share underlying inflammatory and endothelial pathways in a substantial subset of cardiac surgery patients. 

The project will enroll 300 adults undergoing on-pump coronary artery bypass grafting (CABG) and is among the first prospective studies specifically designed to characterize patients who develop both AKI and delirium after cardiac surgery. Preliminary work from the Smith Laboratory suggests that approximately 55% of patients who develop postoperative delirium also experience AKI, potentially defining a distinct subgroup with unique inflammatory and endothelial activation profiles. 

The study's three aims are to determine the incidence and clinical characteristics of this AKI-delirium subgroup, identify inflammatory and endothelial signaling pathways associated with these outcomes, and evaluate whether endogenous high-density lipoprotein (HDL) function is associated with reduced risk of AKI and delirium. 

Investigators will combine detailed clinical assessments with advanced analyses of blood and surgical tissue samples, including biomarker profiling and genomic approaches. Findings from this study may help identify patients at highest risk for postoperative complications, inform the development of future therapeutic strategies, and accelerate translation of discoveries from AKI research into delirium research. 

Congratulations, Dr. Smith!