Preoperative natremia and AKI after cardiac surgery: an international multicenter prospective cohort study.
9 affiliations
- 1Department of Nephrology, Clínica Universidad de Navarra, Pamplona, Spain.
- 2Department of Anesthesiology & Critical Care Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
- 3Department of Anesthesiology & Perioperative Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- 4Department of Anesthesiology & Perioperative Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
- 5Department of Anaesthesia & Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
- 6Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, Pamplona, Spain.
- 7Department of Anesthesiology & Critical Care Medicine, Clínica Universidad de Navarra, Pamplona, Spain. [email protected].
- 8Department of Anesthesiology & Critical Care Medicine, Clínica Universidad de Navarra, Pamplona, Spain. [email protected].
- 9Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain. [email protected].
Abstract
Background and goal of study
Whether preoperative natremia levels may play a role in the development of acute kidney injury (AKI) after cardiac surgery is uncertain. We conducted a cohort study to evaluate the influence of preoperative natremia on AKI in high-risk patients undergoing cardiac surgery.Materials and methods
This multicenter prospective cohort study involved 14 British and Spanish hospitals, each under local ethics committee approval. The study population comprised all consecutive patients aged 18 years or older, with a Cleveland Clinic score ≥ 4, undergoing cardiac surgery from July to December 2017. The resultant 241 consecutive patients were classified according to tertiles of preoperative natremia levels (< 139, > 139-141, and > 141 mmol/L).Results and discussion
The AKIN criteria were used to define AKI. Multivariable logistic regression was used to estimate the adjusted association between preoperative natremia and AKI. A potential link was observed between sodium levels ≤ 139 mmol/L and an increased risk of moderate-to-severe AKI relative to levels above 141 mmol/L (OR 2.01, 95% CI 1.02-3.95, p = 0.03), after multivariable adjustment for age and preoperative serum creatinine. No significant associations were observed between sodium levels and RRT or in-hospital mortality. Conclusions The results from this cohort of high-risk cardiac surgery patients lend tentative support to the hypothesis that preoperative natremia levels ≤ 139 mmol/L might be linked to a higher risk of moderate-to-severe AKI compared with levels above 141 mmol/L. These findings warrant further evaluation in a larger cohort.
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BibTeX
@article{mora2026preoperative,
title = {{Preoperative natremia and AKI after cardiac surgery: an international multicenter prospective cohort study.}},
author = {Jose Maria Mora and Pablo Montero-López and Angel Candela and Esther Gómez and David Nagore and Jorge M Núñez-Córdoba and Gemma Echarri and Raquel Callejas and Marc Vives and on behalf of the Spanish Perioperative Cardiac Surgery Research Group},
journal = {Journal of anesthesia, analgesia and critical care},
year = {2026},
month = jul,
doi = {10.1186/s44158-026-00436-1},
url = {https://europepmc.org/article/MED/42894242},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Preoperative natremia and AKI after cardiac surgery: an international multicenter prospective cohort study.
AU - Jose Maria Mora
AU - Pablo Montero-López
AU - Angel Candela
AU - Esther Gómez
AU - David Nagore
AU - Jorge M Núñez-Córdoba
AU - Gemma Echarri
AU - Raquel Callejas
AU - Marc Vives
AU - on behalf of the Spanish Perioperative Cardiac Surgery Research Group
PY - 2026
DA - 2026/07/01
JO - Journal of anesthesia, analgesia and critical care
DO - 10.1186/s44158-026-00436-1
UR - https://europepmc.org/article/MED/42894242
AB - Background and goal of study Whether preoperative natremia levels may play a role in the development of acute kidney injury (AKI) after cardiac surgery is uncertain. We conducted a cohort study to evaluate the influence of preoperative natremia on AKI in high-risk patients undergoing cardiac surgery.Materials and methods This multicenter prospective cohort study involved 14 British and Spanish hospitals, each under local ethics committee approval. The study population comprised all consecutive patients aged 18 years or older, with a Cleveland Clinic score ≥ 4, undergoing cardiac surgery from July to December 2017. The resultant 241 consecutive patients were classified according to tertiles of preoperative natremia levels (< 139, > 139-141, and > 141 mmol/L).Results and discussion The AKIN criteria were used to define AKI. Multivariable logistic regression was used to estimate the adjusted association between preoperative natremia and AKI. A potential link was observed between sodium levels ≤ 139 mmol/L and an increased risk of moderate-to-severe AKI relative to levels above 141 mmol/L (OR 2.01, 95% CI 1.02-3.95, p = 0.03), after multivariable adjustment for age and preoperative serum creatinine. No significant associations were observed between sodium levels and RRT or in-hospital mortality. Conclusions The results from this cohort of high-risk cardiac surgery patients lend tentative support to the hypothesis that preoperative natremia levels ≤ 139 mmol/L might be linked to a higher risk of moderate-to-severe AKI compared with levels above 141 mmol/L. These findings warrant further evaluation in a larger cohort.
SN - 2731-3786
ER -