Abstract
In recent years, research has questioned the theorized renal-protective value of mannitol infusion during partial nephrectomy. This study considers whether the cessation of routine mannitol administration has shown any benefit or detriment to patients in the contemporary era. We retrospectively reviewed a multi-institution database for an association between mannitol administration and subsequent renal function during follow-up. These patients were assessed for de novo stage III chronic kidney disease (CKD III) and followed with estimated glomerular filtration rate (eGFR). Statistical analysis included Mann–Whitney-U and Chi-squared tests for comparing baseline and perioperative variables with postoperative outcomes. eGFR changes were evaluated with a mixed-effects linear regression model. Nine hundred and fifteen patients were identified whose operative reports or surgeons’ treatment algorithms explicitly described whether or not mannitol was administered. 667 (73%) did not receive mannitol. There were no differences in demographics, age, Charlson comorbidity index, nephrometry score, tumor size, grading, or baseline eGFR from those who received mannitol. Ischemia time and operative time appeared slightly longer with mannitol use. Patients were followed for a median of 5 months (IQR 0.5–19 months), during which mannitol use was associated with an increase in de novo CKD III (14% v. 9%, p = 0.041) and minimally worsened median eGFR on final follow-up (72.82 v. 76.06, p = 0.039). Our analysis of partial nephrectomy patients indicates that mannitol administration likely confers no short- or long-term renal benefit. Mannitol may be used at the surgeon's discretion, but if it prolongs surgery time or ischemia time, it may in fact be detrimental to outcomes.
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Abbreviations
- CKD III:
-
Stage III chronic kidney disease
- eGFR:
-
Estimated glomerular filtration rate
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AB, KB, KEO and GW contributed to the study conception and design. Material preparation and data collection were performed by GW, JW, TD, KEO, EA and VW. Analysis was performed by KEO and TD. The first draft of the manuscript was written by GW, JW, TD, KEO, EA, VW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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George Wayne, Jeffrey Wei, Timothy Demus, Kennedy Okhawere, Elias Atri, Vivian Wong, Ketan Badani, and Akshay Bhandari declare that they have no conflict of interest. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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The study was performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Data collection was IRB approved.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was not obtained given the retrospective review design of this study.
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Wayne, G., Wei, J., Demus, T. et al. Moving away from mannitol infusion for partial nephrectomy: has this altered renal function?. J Robotic Surg 17, 43–48 (2023). https://doi.org/10.1007/s11701-022-01397-7
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DOI: https://doi.org/10.1007/s11701-022-01397-7