This study is a randomized, double-blind, multicenter interventional study to assess safety and efficacy of LSALT peptide versus placebo (matching drug-free saline) in patients undergoing on-pump cardiac surgery. Patients will be followed for safety and efficacy up to Day 28 (EOS), with Day 1 being the day of randomization of study drug at least 1 hour prior to induction of anesthesia.~A total of 240 patients will be included in the study, 120 patients each will be randomized to LSALT peptide or placebo. This study will be double-blinded with only the pharmacist at the site unblinded for the purpose of preparing drug/placebo for injection.~All subjects will undergo tests during the Screening period (window days -14 to -3). After satisfying all inclusion and exclusion criteria, the patient will be randomized equally to the following study arms:~LSALT peptide 10 mg IV administered over 1 hour twice daily, every 12 hours, ± 1hour, for 5 days~Placebo IV administered over 1 hour twice daily, every 12 hours, ± 1 hour, for 5 days~Study treatment will be initiated pre-operatively on Day 1 and continued for 5 days. Physical examinations, vital signs and urine output will be recorded daily throughout the treatment period and on days 6 and 7. Adverse events will be recorded daily throughout the treatment period, on Days 6, 7, and 28 EOS (Day 28 if the patient is not yet discharged from hospital). Kidney function (serum creatinine, serum cystatin C, BUN), clinical laboratory tests, and other biomarkers will be assessed at baseline (prior to initiation of study drug) and monitored daily throughout the treatment period, on Days 6, 7, and EOS (Day 28 if the patient is not yet discharged from hospital). A urinary pregnancy test will be obtained at screening in women of childbearing potential. All patients will be maintained on the standard of care per institutional guidelines. Thus, standard of care (SOC) will be followed in each patient with the addition of LSALT peptide or placebo.~A Data and Safety Monitoring Board (DSMB) will evaluate patients on a continuing basis for primarily safety assessments. Per the DSMB Charter, the DSMB will meet at least monthly if not more frequently based upon enrollment throughout the study period.
To evaluate the percentage of subjects with AKI within 7 days following on-pump cardiac surgery defined by the KDIGO (Kidney Disease: Improving Global Outcomes) criteria:~Increase in baseline (pre-surgery) serum creatinine (SCr) by ≥26.5 μmol/L (≥0.3 mg/dL) within 7 days; OR~Increase in baseline SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the first 7 days following surgery; OR~Urine output < 0.5 mL/kg/h for >6 hours.