{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:07:37Z","timestamp":1788934057975,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac surgery-associated acute kidney injury (CSA-AKI) is driven partly by venous congestion, yet no single bedside measure fully captures volume status: central venous pressure (CVP) reflects venous pressure, not plasma-volume expansion. Whether dynamic estimated plasma volume status (ePVS), a non-invasive marker derived from routine hemoglobin and hematocrit, conveys AKI-relevant information independent of and complementary to CVP is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 4,818 adult patients with coronary artery bypass grafting (CABG) from Medical Information Mart for Intensive Care IV, version 3.0 (MIMIC-IV v3.0), serial ePVS over the first 48\u202fh after admission to the intensive care unit (ICU) was modeled by latent-class linear mixed modeling to identify dynamic phenotypes. The primary outcome was Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) stage \u2265 2 within 72\u202fh. Independence from CVP was tested by the ePVS-CVP correlation, progressive adjustment for admission CVP, CVP-stratified analysis with a trajectory by CVP interaction term, and parallel multiple-mediator analysis (24-h \u0394Hgb, peak CVP, net fluid balance). Forward-time landmark analyses and incremental-value metrics [\u0394 area under the curve (\u0394AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision-curve analysis] were also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four phenotypes emerged: Low-stable (58.5%), Gradually-increasing (6.9%), Rapid-decline (8.7%), and High-stable (25.9%). Admission ePVS and CVP were essentially uncorrelated (Spearman\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.04), indicating non-redundant axes. Only the Gradually-increasing phenotype was independently associated with AKI (Model 3 OR 1.47, 95% CI 1.14 to 1.89), and this was barely changed by adjustment for admission CVP (from 1.58 in Model 1 to 1.49 in Model 2); peak CVP mediated only 9.9% of the total effect, the majority not being attributable to any single measured pathway. Forward-time landmarking amplified the association (OR 2.10 at 24\u202fh; 2.26 at 48\u202fh), arguing against reverse causation. The trajectory-by-CVP interaction was not significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.20); the phenotype effect was numerically larger at low than high admission CVP (OR 1.76 versus 1.20), an exploratory pattern. Adding trajectory class to a static model produced modest gains (NRI 9.9%, IDI 0.4%, \u0394AUC 0.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Four distinct ePVS trajectories within 48\u202fh after CABG carry differential AKI risk. A Gradually-increasing ePVS trajectory after CABG signifies AKI risk that is largely independent of and complementary to CVP, providing a non-invasive volume axis not captured by pressure-based monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1912347","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:58:48Z","timestamp":1788933528000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between dynamic estimated plasma volume trajectories and acute kidney injury after coronary artery bypass grafting"],"prefix":"10.3389","volume":"13","author":[{"given":"Beijun","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Surgical Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"An","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Biological Science and Medical Engineering, Beihang University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianqiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","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":"ref2","doi-asserted-by":"publisher","first-page":"e008834","DOI":"10.1161\/jaha.118.008834","article-title":"Cardiac and vascular surgery-associated acute kidney injury: the 20th international consensus conference of the ADQI (acute disease quality initiative) group","volume":"7","author":"Nadim","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1186\/s13054-023-04640-1","article-title":"Prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis of non-pharmacological interventions","volume":"27","author":"Hariri","year":"2023","journal-title":"Crit Care"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.ccc.2020.11.009","article-title":"Acute kidney injury in cardiac surgery","volume":"37","author":"Massoth","year":"2021","journal-title":"Crit Care Clin"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute kidney injury","volume":"7","author":"Kellum","year":"2021","journal-title":"Nat Rev Dis Prim"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1016\/j.cardfail.2012.10.010","article-title":"Congestive renal failure: the pathophysiology and treatment of renal venous hypertension","volume":"18","author":"Ross","year":"2012","journal-title":"J Card Fail"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1007\/s00134-022-06808-9","article-title":"How can assessing hemodynamics help to assess volume status?","volume":"48","author":"De Backer","year":"2022","journal-title":"Intensive Care Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1172\/JCI102501","article-title":"Water diuresis produced during recumbency by the intravenous infusion of isotonic saline solution","volume":"30","author":"Strauss","year":"1951","journal-title":"J Clin Invest"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1007\/s00392-020-01794-8","article-title":"Estimated plasma volume status in heart failure: clinical implications and future directions","volume":"110","author":"Kobayashi","year":"2021","journal-title":"Clin Res Cardiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1416396","DOI":"10.3389\/fmed.2024.1416396","article-title":"Estimated plasma volume status as a simple and accessible predictor of 28-day mortality in septic shock: insights from a retrospective study of the MIMIC-IV 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Cardiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/s13054-022-04024-x","article-title":"Venous return and mean systemic filling pressure: physiology and clinical applications","volume":"26","author":"Persichini","year":"2022","journal-title":"Crit Care"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1097\/CCM.0b013e3182772ab6","article-title":"The role of venous return in critical illness and shock-part I: physiology","volume":"41","author":"Funk","year":"2013","journal-title":"Crit Care Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"897087","DOI":"10.3389\/fcvm.2022.897087","article-title":"The endothelial glycocalyx: a possible therapeutic target in cardiovascular disorders","volume":"9","author":"Milusev","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1186\/s13054-016-1438-7","article-title":"Volume and its relationship 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