Intravenous Mannitol Versus Placebo During Partial Nephrectomy in Patients with Normal Kidney Function: A Double-blind, Clinically-integrated, Randomized Trial

Spaliviero, Massimiliano; Power, Nicholas; Murray, Katie S.; Sjoberg, Daniel D.; Benfante, Nicole; Bernstein, Melanie; Wren, James; Russo, Paul; Coleman, Jonathan

doi:10.1016/j.eururo.2017.07.038

Cited by 45 publications

(28 citation statements)

References 14 publications

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“…A number of clinical studies have examined the utility of mannitol during PN, including a phase 3, double-blind randomized control trial of 199 patients with estimated GFR (eGFR) > 45 ml/min/1.73 m 2 who underwent PN and were randomized to receive intravenous mannitol or saline placebo at the time of surgery. At 6 wk and 6 mo, renal function outcomes in either group were similar, showing no significant difference [32]. These results were replicated in a single-surgeon randomized control trial of robotic PN of 79 patients using 12 g mannitol [33].…”

Section: Renal Function Preservation In Pnmentioning

confidence: 67%

Examining Mannitol Use in Kidney Cancer Surgery: A Cautionary Tale of Extrapolated Surgical Data

Nair

Power

Coleman

2019

European Urology Focus

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Section: Renal Function Preservation In Pnmentioning

confidence: 67%

Examining Mannitol Use in Kidney Cancer Surgery: A Cautionary Tale of Extrapolated Surgical Data

Nair

Power

Coleman

2019

European Urology Focus

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“…45 A recent RCT by Spaliviero et al studied potential effects of mannitol in nephron sparing surgery in 199 patients with a pre-operative estimated GFR (eGFR) > 45 mL/min/1.73 m 2 . 46 The authors identified no significant differences in eGFR at six weeks or six months, or on renal radionuclear scintigraphy scans at six months. In 65 patients who underwent robotic assisted laparoscopic partial nephrectomy (RALPN), Choi et al observed no difference between individuals receiving 12 g mannitol vs. controls.…”

Section: Mannitol In Renal Surgerymentioning

confidence: 90%

“…In respective studies and the trial by Spaliviero et al, kidney hypothermia was at least partly used as an additional renoprotective measure, primarily in controls. 31,32,46 Mannitol in liver surgery Wahbah et al evaluated different combinations of dopamine and mannitol vs. controls in obstructive jaundice. 50 No differences in any of the chosen end points were noted.…”

Section: Mannitol In Renal Surgerymentioning

confidence: 99%

Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A Systematic Review

Waskowski

Pfortmueller

Erdoes

et al. 2019

European Journal of Vascular and Endovascular Surgery

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Post-operative acute kidney injury (AKI) is known to be an independent risk factor for both short and long-term mortality. The diuretic mannitol is often used in cardiovascular surgery and other surgical fields for renal protection. This systematic review substantiates that peri-operative use of mannitol for AKI prevention should not be considered an evidence based intervention in cardiac and vascular surgery, partial nephrectomy, and/or other major surgery. This is because data mostly derive from heterogeneous cohorts with limited samples size. Further research is required with a focus on patients at high risk of post-operative AKI. Objective/Background: Post-operative acute kidney injury (AKI) is a frequent peri-operative complication that negatively affects morbidity and mortality. Mannitol is frequently used peri-operatively for renal protection, although evidence for its use is ambiguous. A systematic review was conducted to clarify whether there is evidence supporting peri-operative mannitol administration for the prevention of post-operative AKI. Methods: A systematic literature search was performed in MEDLINE/Pubmed, Embase, the Cochrane Library, Clinical Trials registry, and the Cochrane Central Register of Controlled Trials (CENTRAL). Eligibility criteria were (i) population (studies involving adult patients undergoing surgery or a related intervention); (ii) intervention (intravenous mannitol administered in either the pre-or intra-operative period with comparison to controls); and (iii) predefined outcomes (post-operative AKI or respective renal end points/surrogates). Results: In total, 1,538 articles published between January 1990 and October 2018 were identified. After checking for eligibility, 22 studies, including 17 prospective and/or randomised controlled trials and five retrospective studies, were included. The investigations involved various fields of surgery, such as aortic surgery, cardiac surgery with cardiopulmonary bypass, and urological procedures, including partial nephrectomy. Significant heterogeneity, limited sample size, and mostly short follow up periods were noted. Conclusion: Given the available evidence, the peri-operative use of mannitol to prevent AKI cannot be considered an evidence based intervention in cardiac surgery, partial nephrectomy, and/or other major surgery. Further research is required with a focus on patients at high risk of post-operative AKI.

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“…A recent investigation of another flawed concept concluded that administration of mannitol infusion, which was considered to be another factor during NSS, had no significant impact on kidney function as assessed at 6 mo after surgery [10].…”

Section: Evidence Synthesismentioning

confidence: 99%

Does Every Minute of Renal Ischemia Still Count in 2019? Unlocking the Chains of a Flawed Thought Process over Five Decades

Nahar

Bhat

Parekh

2019

European Urology Focus

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Intravenous Mannitol Versus Placebo During Partial Nephrectomy in Patients with Normal Kidney Function: A Double-blind, Clinically-integrated, Randomized Trial

Abstract: In this randomized trial, patients with normal kidney function who received mannitol during surgery to remove part of their kidney had no better kidney function 6 mo after surgery than those who did not receive mannitol. We conclude that this routine practice should be discontinued.

Cited by 45 publications

References 14 publications

Examining Mannitol Use in Kidney Cancer Surgery: A Cautionary Tale of Extrapolated Surgical Data

Examining Mannitol Use in Kidney Cancer Surgery: A Cautionary Tale of Extrapolated Surgical Data

Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: A Systematic Review

Does Every Minute of Renal Ischemia Still Count in 2019? Unlocking the Chains of a Flawed Thought Process over Five Decades

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