Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery

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Aquaporin-2 is found in the apical cell membranes of the principal cells of the collecting duct of the kidney. Plasma arginine vasopressin has been reported to be markedly elevated during cardiac surgery. However fluctuations in urine aquaporin-2 levels have never been reported. We aimed to determine the responses of urine aquaporin-2 and evaluated the relationship between urine aquaporin-2 and plasma arginine vasopressin levels during perioperative periods in cardiac surgical patients. Eight patients undergoing elective isolated aortic valve replacement in normothermia were enrolled prospectively. Blood and urine samples were collected preoperatively and on postoperative days 1, 4, and 7. Patients received furosemide and spironolactone, as needed, during the clinical course; tolvaptan was not needed. Median plasma arginine vasopressin levels [with interquartile range] significantly increased to 1.5 [1.3–2.0], 15.3 [11.4–22.2]*, 2.2 [2.1–2.3], 1.7 [1.5–1.9] pg/mL preoperatively, on postoperative days 1, 4, and 7, respectively (*: p = 0.0001). Similarly, levels of urine aquaporin-2 markedly increased in 3.4 [1.9–5.6], 25.8 [18.4–33.5]**, 9.3 [5.9–14.0], 5.4 [5.3–6.1] (ng/mL), respectively (**p = 0.0004). A significant correlation between plasma arginine vasopressin and urine aquaporin-2 was observed during the entire investigation (R2 = 0.616, p < 0.0001). Plasma arginine vasopressin and urine aquaporin-2 levels were significantly elevated on postoperative day 1 in patients who underwent aortic valve replacement with cardiopulmonary bypass. A significant correlation between plasma arginine vasopressin and urine aquaporin-2 was observed. Urine aquaporin-2 should be further investigated as a potential biomarker for postoperative cardiac dysfunction.

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The authors thank Dr. Kazutora Mizukami, president of Medical Data Management, Fukuoka, for the assistance in the statistical analysis. We would also like to thank Editage ( for English language editing.


This work was supported by JSPS KAKENHI Grant No. JP16K10642.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MF and RA. Funding acquisition was performed by RA. Writing—review and supervision—were performed by RB. The first draft of the manuscript was written by MF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Masahiro Fujii.

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Fujii, M., Amitani, R. & Bessho, R. Perioperative urinary excretion of aquaporin-2 dependent upon vasopressin in cardiac surgery. Heart Vessels 35, 712–718 (2020).

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  • Aquaporin 2
  • Arginine vasopressin
  • Brain natriuretic peptide
  • Cardiopulmonary bypass