{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:32:43Z","timestamp":1786469563300,"version":"build-2736575974"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Low haematocrit during cardiopulmonary bypass is a known risk factor for acute kidney injury, but it is unclear whether high haematocrit also increases acute kidney injury risk. We examined if a haematocrit range associated with a reduced risk for acute kidney injury could be identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational study included cardiac surgery patients operated on between 2016 and 2020, using prospectively collected data from the SWEDEHEART registry and a local cardiopulmonary bypass database. Acute kidney injury was defined by registry-available data as a postoperative serum\u2011creatinine increase &amp;gt;1.5 times baseline or postoperative initiation of renal replacement therapy. For each predefined haematocrit threshold, weighted exposure was calculated as the accumulated time\u2011and\u2011magnitude by which haematocrit rose above or fell below the thresholds. Associations between weighted exposure and acute kidney injury were analysed using multivariable logistic regression adjusted for established acute kidney injury risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3798 patients were included. Postoperative acute kidney injury occurred in 598 of 3798 patients (15.7%). After adjustment, a non\u2011linear association between haematocrit weighted exposure during aortic cross\u2011clamp and acute kidney injury was observed. AKI risk increased with haematocrit below 25% (adjusted odds ratio [aOR] 1.006 per 1 [%\u00d7min]; 95% CI 1.002-1.009; P\u2009&amp;lt;\u2009.001) and above 38% (aOR 1.006 per 1 [%\u00d7min]; 95% CI 1.001-1.011; P\u2009=\u2009.019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cohort, haematocrit exposure below 25% and above 38% during aortic cross-clamp was associated with higher postoperative acute kidney injury risk. Further studies are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag207","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:43:05Z","timestamp":1784893385000},"source":"Crossref","is-referenced-by-count":0,"title":["Haematocrit During Cardiopulmonary Bypass and Risk for Acute Kidney Injury: An Observational Single-Centre Study"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8914-3312","authenticated-orcid":false,"given":"Anders Karl","family":"Hj\u00e4rpe","sequence":"first","affiliation":[{"name":"Department of Perfusion, Sahlgrenska University Hospital , Gothenburg SE-41345,","place":["Sweden"]},{"name":"Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg SE-41345,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2356-2295","authenticated-orcid":false,"given":"Anders","family":"Jeppsson","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Sahlgrenska University Hospital , Gothenburg SE-41345,","place":["Sweden"]},{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg SE-41345,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8280-5210","authenticated-orcid":false,"given":"Lukas","family":"Lannemyr","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg SE-41345,","place":["Sweden"]},{"name":"Department of Cardiothoracic Anaesthesia, Sahlgrenska University Hospital , Gothenburg SE-41345,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8187-9760","authenticated-orcid":false,"given":"Birgitta","family":"Romlin","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg SE-41345,","place":["Sweden"]},{"name":"Department of Paediatric Anaesthesia and Intensive Care, Queen Silvia Children\u2019s Hospital , Gothenburg SE-41650,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"2026081112364608500_ivag207-B1","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/S0003-4975(97)01431-8","article-title":"Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime volume","volume":"65","author":"Shapira","year":"1998","journal-title":"Ann Thorac Surg"},{"key":"2026081112364608500_ivag207-B2","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.athoracsur.2021.07.069","article-title":"Quality management of a comprehensive blood conservation program during cardiopulmonary bypass","volume":"114","author":"Zhang","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"2026081112364608500_ivag207-B3","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/S0022-5223(98)70012-1","article-title":"Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. The Institutions of the Multicenter Study of Perioperative Ischemia (McSPI) Research Group","volume":"116","author":"Spiess","year":"1998","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081112364608500_ivag207-B4","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/02676591211043700","article-title":"Risk factors and treatment of oxygenator high-pressure excursions during cardiopulmonary bypass","volume":"38","author":"Hjarpe","year":"2023","journal-title":"Perfusion"},{"key":"2026081112364608500_ivag207-B5","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1016\/j.athoracsur.2010.08.018","article-title":"Cardiac surgery-associated acute kidney injury: a comparison of two consensus criteria","volume":"90","author":"Robert","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2026081112364608500_ivag207-B6","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1053\/j.jvca.2015.06.017","article-title":"Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis","volume":"30","author":"Hu","year":"2016","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026081112364608500_ivag207-B7","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.amjcard.2013.09.012","article-title":"Minimal changes in postoperative creatinine values and early and late mortality and cardiovascular events after coronary artery bypass grafting","volume":"113","author":"Liotta","year":"2014","journal-title":"Am J Cardiol"},{"key":"2026081112364608500_ivag207-B8","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1186\/s13054-014-0606-x","article-title":"Predictive models for Kidney Disease: Improving Global Outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery","volume":"18","author":"Birnie","year":"2014","journal-title":"Crit Care (Fullerton)"},{"key":"2026081112364608500_ivag207-B9","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1097\/01.CCM.0000171531.06133.B0","article-title":"Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome","volume":"33","author":"Habib","year":"2005","journal-title":"Crit Care Med"},{"key":"2026081112364608500_ivag207-B10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.athoracsur.2013.03.033","article-title":"Association of gender and lowest hematocrit on cardiopulmonary bypass with acute kidney injury and operative mortality in patients undergoing cardiac surgery","volume":"96","author":"Mehta","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2026081112364608500_ivag207-B11","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/aas.14357","article-title":"Cardiopulmonary bypass management and acute kidney injury in cardiac surgery patients","volume":"68","author":"Barbu","year":"2024","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026081112364608500_ivag207-B12","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1136\/hrt.2010.198804","article-title":"The Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART)","volume":"96","author":"Jernberg","year":"2010","journal-title":"Heart"},{"key":"2026081112364608500_ivag207-B13","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.jtcvs.2018.10.148","article-title":"Time\u2013dose response of oxygen delivery during cardiopulmonary bypass predicts acute kidney injury","volume":"158","author":"Mukaida","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081112364608500_ivag207-B14","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1097\/ALN.0000000000004734","article-title":"Acute kidney injury after cardiac surgery: prediction, prevention and management","volume":"139","author":"Cheruku","year":"2023","journal-title":"Anesthesiology"},{"key":"2026081112364608500_ivag207-B15","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1016\/j.jtcvs.2018.04.045","article-title":"Goal-directed perfusion to reduce acute kidney injury: a randomized trial","volume":"156","author":"Ranucci","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026081112364608500_ivag207-B16","doi-asserted-by":"crossref","first-page":"R192","DOI":"10.1186\/cc10349","article-title":"O2 delivery and CO2 production during cardiopulmonary bypass as determinants of acute kidney injury: time for a goal-directed perfusion management?","volume":"15","author":"De Somer","year":"2011","journal-title":"Critical Care"},{"key":"2026081112364608500_ivag207-B17","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1016\/j.athoracsur.2005.05.069","article-title":"Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations","volume":"80","author":"Ranucci","year":"2005","journal-title":"Ann Thorac Surg"},{"key":"2026081112364608500_ivag207-B18","doi-asserted-by":"crossref","DOI":"10.1093\/ejcts\/ezae354","article-title":"2024 EACTS\/EACTAIC\/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery","volume":"67","author":"Wahba","year":"2025","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026081112364608500_ivag207-B19","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/02676591221137033","article-title":"The multifactorial dynamic perfusion index: a predictive tool of cardiac surgery associated acute kidney injury","volume":"39","author":"Ranucci","year":"2024","journal-title":"Perfusion"},{"key":"2026081112364608500_ivag207-B20","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1177\/02676591231211503","article-title":"Cardiac surgery-associated acute kidney injury\u2014a narrative review","volume":"39","author":"Rasmussen","year":"2024","journal-title":"Perfusion"},{"key":"2026081112364608500_ivag207-B21","doi-asserted-by":"crossref","first-page":"e70139","DOI":"10.1111\/aas.70139","article-title":"Dextran vs. Crystalloid priming solution in cardiac surgery: a randomized trial on acute kidney injury","volume":"70","author":"Juvakka","year":"2026","journal-title":"Acta Anaesthesiol Scand"},{"key":"2026081112364608500_ivag207-B22","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1186\/cc14726","article-title":"Hemodynamic coherence and the rationale for monitoring the microcirculation","volume":"19","author":"Ince","year":"2015","journal-title":"Critical Care"},{"key":"2026081112364608500_ivag207-B23","first-page":"183","article-title":"Capillary blood viscosity in microcirculation","volume":"35","author":"Cortinovis","year":"2006","journal-title":"Clin Hemorheol Microcirc"},{"key":"2026081112364608500_ivag207-B24","doi-asserted-by":"crossref","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clinical Practice"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag207\/70097470\/ivag207.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/8\/ivag207\/70097470\/ivag207.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/8\/ivag207\/70097470\/ivag207.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:36:59Z","timestamp":1786466219000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag207\/8742043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":24,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8,3]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag207","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,25]]},"article-number":"ivag207"}}