{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T01:31:08Z","timestamp":1787880668262,"version":"build-2784847793"},"reference-count":26,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery bypass grafting (OPCABG). Methods: For this single-center observational cohort study, 70 patients undergoing OPCABG were enrolled (diuresis: urine output &gt; 5 mL\/kg\/h, n = 38; normal, n = 32). Hormonal markers and osmolality parameters were measured perioperatively. Logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) curves was used to assess model performance. Results: Intraoperative high-volume diuresis occurred in 54.2% of patients. Logistic regression identified a low Body Mass Index (BMI) (OR 0.72, p = 0.002), reduced albumin (OR 0.75, p = 0.014), and lower copeptin (OR 0.43, p = 0.037) as independent predictors (AUC 0.855). Perioperatively, NT-proBNPT0 rose in both groups, aldosterone increased only in the diuresis group, and copeptin showed a slight nonsignificant rise. Plasma sodium was higher in cases of diuresis at the end of surgery (148.4 vs. 144.9 mmol\/L, p &lt; 0.001). Despite greater urine output and fluid infusion, the rates of intensive care unit (ICU) admission and hospital stays were similar. Conclusions: Intraoperative high-volume diuresis in OPCABG is strongly associated with reduced antidiuretic hormone activity, suggesting a partial central diabetes insipidus-like mechanism. Although not affecting short-term outcomes, it posed challenges for intraoperative fluid and electrolyte management. Larger multicenter studies are needed for validation.<\/jats:p>","DOI":"10.3390\/jcm14238395","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T14:39:43Z","timestamp":1764167983000},"page":"8395","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hormonal and Osmoregulatory Responses in Intraoperative High-Volume Diuresis During Off-Pump Coronary Artery Bypass Grafting: An Exploratory Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3400-1856","authenticated-orcid":false,"given":"Yuxi","family":"Hou","sequence":"first","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuwen","family":"Li","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Cai","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangyi","family":"Luo","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ma","sequence":"additional","affiliation":[{"name":"Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1186\/s13019-024-02833-5","article-title":"Establishment and validation of a predictive nomogram for polyuria during general anesthesia in thoracic surgery","volume":"19","author":"Li","year":"2024","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s44158-022-00045-8","article-title":"Perioperative hypotension: Causes and remedies","volume":"2","author":"Guarracino","year":"2022","journal-title":"J. Anesth. Analg. Crit. Care."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1213\/ANE.0000000000005344","article-title":"Perioperative Diabetes Insipidus Caused by Anesthetic Medications: A Review of the Literature","volume":"134","author":"Reynolds","year":"2022","journal-title":"Anesth. Analg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/neuonc\/nov189","article-title":"CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2008\u20132012","volume":"17","author":"Ostrom","year":"2015","journal-title":"Neuro-Oncology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/ejendo\/lvae084","article-title":"Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: A systematic review and meta-analysis","volume":"191","author":"Fountas","year":"2024","journal-title":"Eur. J. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"523","DOI":"10.5005\/jp-journals-10071-23278","article-title":"Central Diabetes Insipidus in an Off-pump Coronary Artery Bypass Grafting Surgery","volume":"23","author":"Nasa","year":"2019","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_7","first-page":"S10","article-title":"Transient Diabetes Insipidus Following Cardiopulmonary Bypass","volume":"25","author":"Ekim","year":"2015","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_8","first-page":"99","article-title":"Temporary diabetes insipidus in 2 men after on-pump coronary artery bypass grafting","volume":"40","author":"Uyar","year":"2013","journal-title":"Tex. Heart Inst. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s11102-020-01083-7","article-title":"Postoperative diabetes insipidus: How to define and grade this complication?","volume":"24","author":"Lobatto","year":"2021","journal-title":"Pituitary"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Okamoto, R., Ali, Y., Hashizume, R., Suzuki, N., and Ito, M. (2019). BNP as a Major Player in the Heart-Kidney Connection. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20143581"},{"key":"ref_11","first-page":"301","article-title":"Polyuria in adults. A diagnostic approach based on pathophysiology","volume":"222","year":"2022","journal-title":"Rev. Clin. Esp."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1053\/j.ajkd.2015.10.021","article-title":"Evaluation of Polyuria: The Roles of Solute Loading and Water Diuresis","volume":"67","author":"Bhasin","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.33176\/AACB-20-00001","article-title":"The Emerging Role of Copeptin","volume":"42","author":"Jalleh","year":"2021","journal-title":"Clin. Biochem. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1210\/jc.2014-4507","article-title":"Diagnostic Accuracy of Copeptin in the Differential Diagnosis of the Polyuria-polydipsia Syndrome: A Prospective Multicenter Study","volume":"100","author":"Timper","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1111\/imj.13627","article-title":"Polyuria-polydipsia syndrome: A diagnostic challenge","volume":"48","author":"Nigro","year":"2018","journal-title":"Intern. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1038\/nrendo.2015.224","article-title":"Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis","volume":"12","author":"Fenske","year":"2016","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/joim.13261","article-title":"Diagnosis and management of diabetes insipidus for the internist: An update","volume":"290","author":"Winzeler","year":"2021","journal-title":"J. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/cen.13991","article-title":"Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis","volume":"91","author":"Refardt","year":"2019","journal-title":"Clin. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1016\/j.jacc.2004.07.057","article-title":"Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia","volume":"44","author":"Sabatine","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.ijcard.2014.08.032","article-title":"Natriuretic peptides and cardio-renal disease","volume":"176","author":"Volpe","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Caputo, I., Bertoldi, G., Driussi, G., Cacciapuoti, M., and Cal\u00f2, L.A. (2023). The RAAS Goodfellas in Cardiovascular System. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216873"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Krenn, K., H\u00f6bart, P., Adam, L., Riemann, G., Christiansen, F., Domenig, O., and Ullrich, R. (2024). Intra- and postoperative relative angiotensin II deficiency in patients undergoing elective major abdominal surgery. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1375409"},{"key":"ref_23","first-page":"27","article-title":"Hyponatremia after trans-sphenoidal surgery","volume":"39","author":"Janneck","year":"2014","journal-title":"Minerva Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.2169\/internalmedicine.48.2021","article-title":"Severe hyponatremia due to inappropriate secretion of antidiuretic hormone following pleurodesis","volume":"48","author":"Higashihara","year":"2009","journal-title":"Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"614","DOI":"10.4103\/ija.IJA_456_17","article-title":"Perioperative fluid management: From physiology to improving clinical outcomes","volume":"61","author":"Bennett","year":"2017","journal-title":"Indian J. Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/jocs.13968","article-title":"Vasopressin therapy in cardiac surgery","volume":"34","author":"Kunkes","year":"2019","journal-title":"J. Card. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8395\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:22:32Z","timestamp":1764307352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":26,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238395"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238395","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]}}}