URINE OUTPUT – A CRITICAL VITAL SIGN AND THERAPEUTIC TARGET IN CARDIAC SURGERY
Main Article Content
Abstract
Cardiac surgery associated acute kidney injury is one of the most serious adverse events occurring in this population. To date, there are no widely accepted therapies for treating cardiac surgery associated acute kidney injury once it occurs; therefore, prevention is most important. Multiple therapies have been proposed for prevention of cardiac surgery associated acute kidney injury but none has been successful and uniformly adopted by anesthesia and surgical societies. In the review that follows, I propose a new approach to prevention of cardiac surgery associated acute kidney injury based upon a readily available marker of kidney function, urine flow rate. The relationship of urine flow rate to cardiac surgery associated acute kidney injury and the effects of raising urine flow rate with diuretics is discussed. The physiology behind the beneficial effects of high urine flow rate is applicable to other causes of acute kidney injury.
Keywords:
Cardiac surgery, Acute kidney injury, Urine flow rate, Urine output, Diuretics, Renal protection, Perioperative monitoring, Prevention strategies, Renal physiology
Article Details
How to Cite
SOLOMON, Richard.
URINE OUTPUT – A CRITICAL VITAL SIGN AND THERAPEUTIC TARGET IN CARDIAC SURGERY.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6858>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6858.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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7. Myles PS, McIlroy DR, Bellomo R, Wallace S. Importance of intraoperative oliguria during major abdominal surgery: findings of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery trial. Br J Anaesth. Jun 2019;122(6):726-733. doi:10.1016/j.bja.2019.01.010
8. Shiba A, Uchino S, Fujii T, Takinami M, Uezono S. Association Between Intraoperative Oliguria and Acute Kidney Injury After Major Noncardiac Surgery. Anesth Analg. Nov 2018;127(5):1229-1235. doi:10.1213/ANE.0000000000003576
9. du Toit L, Biccard BM. The relationship between intraoperative oliguria and acute kidney injury. Br J Anaesth. Jun 2019;122(6):707-710. doi:10.1016/j.bja.2019.03.008
10. Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth. Dec 2015;115 Suppl 2:ii3-14. doi:10.1093/bja/aev380
11. Zhao BC, Lei SH, Yang X, et al. Assessment of prognostic value of intraoperative oliguria for postoperative acute kidney injury: a retrospective cohort study. Br J Anaesth. Apr 2021;126(4):799-807. doi:10.1016/j.bja.2020.11.018
12. Egal M, de Geus HRH, van Bommel J, Groeneveld ABJ. Targeting oliguria reversal in perioperative restrictive fluid management does not influence the occurrence of renal dysfunction: A systematic review and meta-analysis. European Journal of Anaesthesiology EJA.2016;33(6):425-435. doi:10.1097/eja.0000000000000416
13. Egal M, Erler NS, de Geus HRH, van Bommel J, Groeneveld ABJ. Targeting Oliguria Reversal in Goal- Directed Hemodynamic Management Does Not Reduce Renal Dysfunction in Perioperative and Critically Ill Patients: A Systematic Review and Meta- Analysis. Anesthesia & Analgesia. 2016;122(1):173-185. doi:10.1213/ane.000000000000102
14. Kamla CE, Meersch-Dini M, Palma LMP. Kidney Injury Following Cardiac Surgery: A Review of Our Current Understanding. Am J Cardiovasc Drugs. May 2025;25(3):337-348. doi:10.1007/s40256-024-00715-8
15. Hori D, Katz NM, Fine DM, et al. Defining oliguria during cardiopulmonary bypass and its relationship with cardiac surgery-associated acute kidney injury. Br J Anaesth. Dec 2016;117(6):733-740. doi:10.1093/bja/aew340
16. Yilmaz M, Aksoy R, Kilic Yilmaz V, Balci C, Duzyol C, Tekeli Kunt A. Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting. Heart Surg Forum. Dec 16 2016;19(6):E289-E293. doi:10.1532/hsf.1495
17. Song Y, Kim DW, Kwak YL, et al. Urine Output During Cardiopulmonary Bypass Predicts Acute Kidney Injury After Cardiac Surgery: A Single-Center Retrospective Analysis. Medicine (Baltimore). May 2016;95(22):e3757. doi:10.1097/MD.0000000000003757
18. Bie D, Li Y, Wang H, et al. Relationship between intra-operative urine output and postoperative acute kidney injury in paediatric cardiac surgery: A retrospective observational study. Eur J Anaesthesiol. Dec 1 2024;41(12):881-888. doi:10.1097/EJA.0000000000002044
19. Yallop KG, Sheppard SV, Smith DC. The effect of mannitol on renal function following cardio- pulmonary bypass in patients with normal pre- operative creatinine. Anaesthesia. Jun 2008;63(6):576-82. doi:10.1111/j.1365-2044.2008.05540.x
20. Smith MN, Best D, Sheppard SV, Smith DC. The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction. Anaesthesia. Jul 2008;63(7):701-4. doi:10.1111/j.1365-2044.2007.05408.x
21. Sköld A, Dardashti A, Lindstedt S, Hyllén S. No benefit of adding mannitol to cardiopulmonary bypass priming solution assessing cystatin C. A randomized clinical trial. Perfusion. May 24 2025:2676591251344857. doi:10.1177/02676591251344857
22. Saleem M, Awan AH, Mushtaq A. Effect of Mannitol on Electrolytes and Its Relation with Kidney Injury in Cardiopulmonary Bypass. Biological and Clinical Sciences Research Journal. 2023;2023(1)doi:10.54112/bcsrj.v2023i1.535
23. Hemmati Maslakpak M, Bilejani E, Negargar S, Khalili A, Alinejad V, Faravan A. The effect of mannitol on postoperative renal function in patients undergoing coronary artery bypass surgery: A double-blinded randomized controlled trial. J Cardiovasc Thorac Res.2024;16(3):146-151. doi:10.34172/jcvtr.32992
24. Svenmarker S, Claesson Lingehall H, Malmqvist G, Appelblad M. Plasma hyperosmolality during cardiopulmonary bypass is a risk factor for postoperative acute kidney injury: Results from double blind randomised controlled trial. Perfusion. Mar 2025;40(2):466-474. doi:10.1177/02676591241240726
25. Sköld A, Dardashti A, Lindstedt S, Hyllén S. No benefit of adding mannitol to cardiopulmonary bypass priming solution assessing cystatin C. A randomized clinical trial. Perfusion. 0(0):02676591251344857. doi:10.1177/02676591251344857
26. Waskowski J, Pfortmueller CA, Erdoes G, et al. Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A Systematic Review. Eur J Vasc Endovasc Surg. Jul 2019;58(1):130-140. doi:10.1016/j.ejvs.2019.02.003
27. Brown JR, Baker RA, Shore-Lesserson L, et al. The Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology Clinical Practice Guidelines for the Prevention of Adult Cardiac Surgery- Associated Acute Kidney Injury. Ann Thorac Surg. Jan 2023;115(1):34-42.
doi:10.1016/j.athoracsur.2022.06.054
28. Redfors B, Swärd K, Sellgren J, Ricksten SE. Effects of mannitol alone and mannitol plus furosemide on renal oxygen consumption, blood flow and glomerular filtration after cardiac surgery. Intensive Care Med. Jan 2009;35(1):115-22. doi:10.1007/s00134-008-1206-5
29. Kumada Y, Yoshitani K, Shimabara Y, Ohnishi Y. Perioperative risk factors for acute kidney injury after off-pump coronary artery bypass grafting: a retrospective study. JA Clin Rep. 2017;3(1):55. doi:10.1186/s40981-017-0125-2
30. Moreira R, Jacinto T, Neves P, Vouga L, Baeta C. Predictors of Acute Kidney Injury Associated with Cardiopulmonary Bypass. Rev Port Cir Cardiotorac Vasc. Apr-Jun 2019;26(2):109-115.
31. Parolari A, Pesce LL, Pacini D, et al. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. Ann Thorac Surg. Feb 2012;93(2):584-91. doi:10.1016/j.athoracsur.2011.09.073
32. Maruniak S, Loskutov O, Swol J, Todurov B. Factors associated with acute kidney injury after on- pump coronary artery bypass grafting. J Cardiothorac Surg. Oct 8 2024;19(1):598. doi:10.1186/s13019-024-03103-0
33. Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol. Jan 2000;11(1):97-104. doi:10.1681/asn.V11197
34. Fakhari S, Bavil FM, Bilehjani E, Abolhasani S, Mirinazhad M, Naghipour B. Prophylactic furosemide infusion decreasing early major postoperative renal dysfunction in on-pump adult cardiac surgery: a randomized clinical trial. Res Rep Urol. 2017;9:5-13. doi:10.2147/rru.S126134
35. Mahesh B, Yim B, Robson D, Pillai R, Ratnatunga C, Pigott D. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg. Mar 2008;33(3):370-6. doi:10.1016/j.ejcts.2007.12.030
36. Xie CM, Yao YT, Yang K, et al. Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis. J Card Surg. Dec 2022;37(12):4850- 4860. doi:10.1111/jocs.17120
37. Luckraz H, Giri R, Wrigley B, et al. Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial. Eur J Cardiothorac Surg. Apr 13 2021;59(3):562-569. doi:10.1093/ejcts/ezaa395
38. Putzu A, Boscolo Berto M, Belletti A, et al. Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With Matched Hydration in Patients Undergoing Interventional Procedures: A Systematic Review and Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. Feb 27 2017;10(4):355-363. doi:10.1016/j.jcin.2016.11.006
39. Zhang W, Zhang J, Yang B, et al. Effectiveness of oral hydration in preventing contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention: a pairwise and network meta-analysis. Coronary artery disease. Jun 2018;29(4):286-293. doi:10.1097/MCA.0000000000000607
40. Romano G, Briguori C, Quintavalle C, et al. Contrast agents and renal cell apoptosis. Eur Heart J. Oct 2008;29(20):2569-76. doi:10.1093/eurheartj/ehn197
41. Chu LL, Katzberg RW, Solomon R, et al. Clinical Significance of Persistent Global and Focal Computed Tomography Nephrograms After Cardiac Catheterization and Their Relationships to Urinary Biomarkers of Kidney Damage and Procedural Factors: Pilot Study. Invest Radiol. Dec 2016;51(12):797-803. doi:10.1097/RLI.0000000000000268
42. Ben-Haim Y, Chorin E, Hochstadt A, et al. Forced Diuresis with Matched Isotonic Intravenous Hydration Prevents Renal Contrast Media Accumulation. J Clin Med. Feb 8 2022;11(3)doi:10.3390/jcm11030885
43. Leaf DE, Rajapurkar M, Lele SS, et al. Increased plasma catalytic iron in patients may mediate acute kidney injury and death following cardiac surgery. Kidney Int. May 2015;87(5):1046-54. doi:10.1038/ki.2014.374
44. Prasad PV, Epstein FH. Changes in renal medullary pO2 during water diuresis as evaluated by blood oxygenation level-dependent magnetic resonance imaging: effects of aging and cyclooxygenase inhibition. Kidney Int. Jan 1999;55(1):294-8. doi:10.1046/j.1523-1755.1999.00237.
45. Prasad PV, Priatna A, Spokes K, Epsein F. Changes in intrarenal oxygenation as evaluated by BOLD MRI in a rat kidney model for radiocontrast nephropathy. J Magn Reson Imaging. 2011;13:744-47.
46. Xie W, Zhou Y, Liao Z, Lin B. Effect of Oral Hydration on Contrast-Induced Acute Kidney Injury among Patients after Primary Percutaneous Coronary Intervention. Cardiorenal medicine. 2021;11(5-6):243-251. doi:10.1159/000520088
2. Kunst G, Ostermann M. Intraoperative permissive oliguria - how much is too much? Br J Anaesth. Dec 1 2017;119(6):1075-1077. doi:10.1093/bja/aex387
3. Mizota T, Yamamoto Y, Hamada M, Matsukawa S, Shimizu S, Kai S. Intraoperative oliguria predicts acute kidney injury after major abdominal surgery. Br J Anaesth. Dec 1 2017;119(6):1127-1134.
doi:10.1093/bja/aex255
4. Myles PS, Bellomo R, Corcoran T, et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. Jun 14 2018;378(24):2263-2274. doi:10.1056/NEJMoa1801601
5. Ostermann M, Shaw AD, Joannidis M. Management of oliguria. Intensive Care Med. Jan 2023;49(1):103-106. doi:10.1007/s00134-022-06909-5
6. Pang Z, Liang S, Xing M, Zhou N, Guo Q, Zou W. The correlation of intraoperative oliguria with acute kidney injury after noncardiac surgery: a systematic review and meta-analysis. Int J Surg. Mar 1 2023;109(3):449-457. doi:10.1097/JS9.0000000000000284
7. Myles PS, McIlroy DR, Bellomo R, Wallace S. Importance of intraoperative oliguria during major abdominal surgery: findings of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery trial. Br J Anaesth. Jun 2019;122(6):726-733. doi:10.1016/j.bja.2019.01.010
8. Shiba A, Uchino S, Fujii T, Takinami M, Uezono S. Association Between Intraoperative Oliguria and Acute Kidney Injury After Major Noncardiac Surgery. Anesth Analg. Nov 2018;127(5):1229-1235. doi:10.1213/ANE.0000000000003576
9. du Toit L, Biccard BM. The relationship between intraoperative oliguria and acute kidney injury. Br J Anaesth. Jun 2019;122(6):707-710. doi:10.1016/j.bja.2019.03.008
10. Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth. Dec 2015;115 Suppl 2:ii3-14. doi:10.1093/bja/aev380
11. Zhao BC, Lei SH, Yang X, et al. Assessment of prognostic value of intraoperative oliguria for postoperative acute kidney injury: a retrospective cohort study. Br J Anaesth. Apr 2021;126(4):799-807. doi:10.1016/j.bja.2020.11.018
12. Egal M, de Geus HRH, van Bommel J, Groeneveld ABJ. Targeting oliguria reversal in perioperative restrictive fluid management does not influence the occurrence of renal dysfunction: A systematic review and meta-analysis. European Journal of Anaesthesiology EJA.2016;33(6):425-435. doi:10.1097/eja.0000000000000416
13. Egal M, Erler NS, de Geus HRH, van Bommel J, Groeneveld ABJ. Targeting Oliguria Reversal in Goal- Directed Hemodynamic Management Does Not Reduce Renal Dysfunction in Perioperative and Critically Ill Patients: A Systematic Review and Meta- Analysis. Anesthesia & Analgesia. 2016;122(1):173-185. doi:10.1213/ane.000000000000102
14. Kamla CE, Meersch-Dini M, Palma LMP. Kidney Injury Following Cardiac Surgery: A Review of Our Current Understanding. Am J Cardiovasc Drugs. May 2025;25(3):337-348. doi:10.1007/s40256-024-00715-8
15. Hori D, Katz NM, Fine DM, et al. Defining oliguria during cardiopulmonary bypass and its relationship with cardiac surgery-associated acute kidney injury. Br J Anaesth. Dec 2016;117(6):733-740. doi:10.1093/bja/aew340
16. Yilmaz M, Aksoy R, Kilic Yilmaz V, Balci C, Duzyol C, Tekeli Kunt A. Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting. Heart Surg Forum. Dec 16 2016;19(6):E289-E293. doi:10.1532/hsf.1495
17. Song Y, Kim DW, Kwak YL, et al. Urine Output During Cardiopulmonary Bypass Predicts Acute Kidney Injury After Cardiac Surgery: A Single-Center Retrospective Analysis. Medicine (Baltimore). May 2016;95(22):e3757. doi:10.1097/MD.0000000000003757
18. Bie D, Li Y, Wang H, et al. Relationship between intra-operative urine output and postoperative acute kidney injury in paediatric cardiac surgery: A retrospective observational study. Eur J Anaesthesiol. Dec 1 2024;41(12):881-888. doi:10.1097/EJA.0000000000002044
19. Yallop KG, Sheppard SV, Smith DC. The effect of mannitol on renal function following cardio- pulmonary bypass in patients with normal pre- operative creatinine. Anaesthesia. Jun 2008;63(6):576-82. doi:10.1111/j.1365-2044.2008.05540.x
20. Smith MN, Best D, Sheppard SV, Smith DC. The effect of mannitol on renal function after cardiopulmonary bypass in patients with established renal dysfunction. Anaesthesia. Jul 2008;63(7):701-4. doi:10.1111/j.1365-2044.2007.05408.x
21. Sköld A, Dardashti A, Lindstedt S, Hyllén S. No benefit of adding mannitol to cardiopulmonary bypass priming solution assessing cystatin C. A randomized clinical trial. Perfusion. May 24 2025:2676591251344857. doi:10.1177/02676591251344857
22. Saleem M, Awan AH, Mushtaq A. Effect of Mannitol on Electrolytes and Its Relation with Kidney Injury in Cardiopulmonary Bypass. Biological and Clinical Sciences Research Journal. 2023;2023(1)doi:10.54112/bcsrj.v2023i1.535
23. Hemmati Maslakpak M, Bilejani E, Negargar S, Khalili A, Alinejad V, Faravan A. The effect of mannitol on postoperative renal function in patients undergoing coronary artery bypass surgery: A double-blinded randomized controlled trial. J Cardiovasc Thorac Res.2024;16(3):146-151. doi:10.34172/jcvtr.32992
24. Svenmarker S, Claesson Lingehall H, Malmqvist G, Appelblad M. Plasma hyperosmolality during cardiopulmonary bypass is a risk factor for postoperative acute kidney injury: Results from double blind randomised controlled trial. Perfusion. Mar 2025;40(2):466-474. doi:10.1177/02676591241240726
25. Sköld A, Dardashti A, Lindstedt S, Hyllén S. No benefit of adding mannitol to cardiopulmonary bypass priming solution assessing cystatin C. A randomized clinical trial. Perfusion. 0(0):02676591251344857. doi:10.1177/02676591251344857
26. Waskowski J, Pfortmueller CA, Erdoes G, et al. Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A Systematic Review. Eur J Vasc Endovasc Surg. Jul 2019;58(1):130-140. doi:10.1016/j.ejvs.2019.02.003
27. Brown JR, Baker RA, Shore-Lesserson L, et al. The Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology Clinical Practice Guidelines for the Prevention of Adult Cardiac Surgery- Associated Acute Kidney Injury. Ann Thorac Surg. Jan 2023;115(1):34-42.
doi:10.1016/j.athoracsur.2022.06.054
28. Redfors B, Swärd K, Sellgren J, Ricksten SE. Effects of mannitol alone and mannitol plus furosemide on renal oxygen consumption, blood flow and glomerular filtration after cardiac surgery. Intensive Care Med. Jan 2009;35(1):115-22. doi:10.1007/s00134-008-1206-5
29. Kumada Y, Yoshitani K, Shimabara Y, Ohnishi Y. Perioperative risk factors for acute kidney injury after off-pump coronary artery bypass grafting: a retrospective study. JA Clin Rep. 2017;3(1):55. doi:10.1186/s40981-017-0125-2
30. Moreira R, Jacinto T, Neves P, Vouga L, Baeta C. Predictors of Acute Kidney Injury Associated with Cardiopulmonary Bypass. Rev Port Cir Cardiotorac Vasc. Apr-Jun 2019;26(2):109-115.
31. Parolari A, Pesce LL, Pacini D, et al. Risk factors for perioperative acute kidney injury after adult cardiac surgery: role of perioperative management. Ann Thorac Surg. Feb 2012;93(2):584-91. doi:10.1016/j.athoracsur.2011.09.073
32. Maruniak S, Loskutov O, Swol J, Todurov B. Factors associated with acute kidney injury after on- pump coronary artery bypass grafting. J Cardiothorac Surg. Oct 8 2024;19(1):598. doi:10.1186/s13019-024-03103-0
33. Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol. Jan 2000;11(1):97-104. doi:10.1681/asn.V11197
34. Fakhari S, Bavil FM, Bilehjani E, Abolhasani S, Mirinazhad M, Naghipour B. Prophylactic furosemide infusion decreasing early major postoperative renal dysfunction in on-pump adult cardiac surgery: a randomized clinical trial. Res Rep Urol. 2017;9:5-13. doi:10.2147/rru.S126134
35. Mahesh B, Yim B, Robson D, Pillai R, Ratnatunga C, Pigott D. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg. Mar 2008;33(3):370-6. doi:10.1016/j.ejcts.2007.12.030
36. Xie CM, Yao YT, Yang K, et al. Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis. J Card Surg. Dec 2022;37(12):4850- 4860. doi:10.1111/jocs.17120
37. Luckraz H, Giri R, Wrigley B, et al. Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial. Eur J Cardiothorac Surg. Apr 13 2021;59(3):562-569. doi:10.1093/ejcts/ezaa395
38. Putzu A, Boscolo Berto M, Belletti A, et al. Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With Matched Hydration in Patients Undergoing Interventional Procedures: A Systematic Review and Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. Feb 27 2017;10(4):355-363. doi:10.1016/j.jcin.2016.11.006
39. Zhang W, Zhang J, Yang B, et al. Effectiveness of oral hydration in preventing contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention: a pairwise and network meta-analysis. Coronary artery disease. Jun 2018;29(4):286-293. doi:10.1097/MCA.0000000000000607
40. Romano G, Briguori C, Quintavalle C, et al. Contrast agents and renal cell apoptosis. Eur Heart J. Oct 2008;29(20):2569-76. doi:10.1093/eurheartj/ehn197
41. Chu LL, Katzberg RW, Solomon R, et al. Clinical Significance of Persistent Global and Focal Computed Tomography Nephrograms After Cardiac Catheterization and Their Relationships to Urinary Biomarkers of Kidney Damage and Procedural Factors: Pilot Study. Invest Radiol. Dec 2016;51(12):797-803. doi:10.1097/RLI.0000000000000268
42. Ben-Haim Y, Chorin E, Hochstadt A, et al. Forced Diuresis with Matched Isotonic Intravenous Hydration Prevents Renal Contrast Media Accumulation. J Clin Med. Feb 8 2022;11(3)doi:10.3390/jcm11030885
43. Leaf DE, Rajapurkar M, Lele SS, et al. Increased plasma catalytic iron in patients may mediate acute kidney injury and death following cardiac surgery. Kidney Int. May 2015;87(5):1046-54. doi:10.1038/ki.2014.374
44. Prasad PV, Epstein FH. Changes in renal medullary pO2 during water diuresis as evaluated by blood oxygenation level-dependent magnetic resonance imaging: effects of aging and cyclooxygenase inhibition. Kidney Int. Jan 1999;55(1):294-8. doi:10.1046/j.1523-1755.1999.00237.
45. Prasad PV, Priatna A, Spokes K, Epsein F. Changes in intrarenal oxygenation as evaluated by BOLD MRI in a rat kidney model for radiocontrast nephropathy. J Magn Reson Imaging. 2011;13:744-47.
46. Xie W, Zhou Y, Liao Z, Lin B. Effect of Oral Hydration on Contrast-Induced Acute Kidney Injury among Patients after Primary Percutaneous Coronary Intervention. Cardiorenal medicine. 2021;11(5-6):243-251. doi:10.1159/000520088