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Acute kidney injury (AKI) is a significant complication of cardiac surgery and is associated with increased morbidity and mortality [1]. Despite much research, there is no specific therapy available. Although AKI can be multifactorial, ischaemia reperfusion injury (IRI) often plays a key role. Thus, cardiac surgery offers an attractive opportunity for translational AKI research given the predictive haemodynamic challenge to renal perfusion.Hemeoxygenase-1 (HO-1) is a key inducible anti-inflammatory enzyme that catalyses the breakdown of the pro-oxidant protein heme ubiquitously found at inflamed sites. The drug heme arginate has been in use for over 20 years in the treatment of porphyria but also upregulates HO-1 in peripheral blood mononuclear cells (PBMCs) [2] and ameliorates calf muscle ischaemia [3]. In addition, treatment of mice with heme arginate prior to renal IRI strongly upregulates renal HO-1 expression and protects from AKI [4]. We therefore hypothesise that HA may offer a prophylactic therapy for human renal IRI via the upregulation of HO-1.

Clinical Trial: Heme Arginate in patients planned for Cardiac Surgery (HACS)