Patients with acute kidney injury requiring renal replacement therapy after cardiac surgery were statistically more likely to have pre-operative impaired renal function, hypertension, diabetes mellitus requiring insulin, chronic obstructive pulmonary disease, and congestive heart failure, or use of pre-operative intra-aortic balloon pump (IABP), or cardiogenic shock. The gene discussed is INS; the disease is chronic obstructive pulmonary disease.