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Association between preoperative hydration and cardiac surgery-associated acute kidney injury: a prospective

Ghaith Mohsen1,2, Julia Wallqvist3, Zheng-Yii Lee4,5,6

  • 1Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburgerplatz 1, 13353, Berlin, Germany. Ghaith.mohsen@dhzc-charite.de.

Journal of Cardiothoracic Surgery
|July 23, 2026
PubMed

Insights

Lower preoperative fluid intake is linked to increased cardiac surgery-associated acute kidney injury (CSA-AKI) risk. Optimizing patient hydration before surgery may help prevent CSA-AKI.

Area of Science:

  • Nephrology
  • Cardiology
  • Surgical Complications

Background:

  • Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication post-cardiopulmonary bypass (CPB).
  • Limited understanding exists regarding CSA-AKI pathophysiology and prevention, particularly concerning preoperative hydration.
  • Preoperative oral hydration is a potentially modifiable factor influencing CSA-AKI outcomes.

Purpose of the Study:

  • To investigate the association between preoperative oral fluid intake and CSA-AKI in patients undergoing elective cardiac surgery with CPB.
  • To identify potential thresholds for preoperative hydration that may mitigate CSA-AKI risk.

Main Methods:

  • Prospective, observational, single-center study.
  • Preoperative fluid intake was estimated via patient self-reporting (ml/h).
  • ROC analysis determined a threshold of 51.5 ml/h to stratify patients into low and high intake groups.

Main Results:

  • 16.3% of 92 patients developed CSA-AKI.
  • Lower preoperative fluid intake (<51.5 ml/h) was significantly associated with higher CSA-AKI incidence (33.3% vs. 3.8%, p<0.001).
  • The low-intake group showed increased renal replacement therapy (RRT) need and longer intervals between last oral intake and anesthesia induction.

Conclusions:

  • Reduced preoperative oral fluid intake correlates with elevated CSA-AKI rates post-cardiac surgery.
  • An exploratory threshold of 51.5 ml/h for preoperative fluid intake was identified.
  • Prospective studies are needed to validate these exploratory findings and thresholds.
Abstract

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