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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
09:02

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Published on: February 2, 2021

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Acute kidney injury in patients with malignant middle cerebral artery infarction undergoing hyperosmolar therapy with

Haidar Moustafa1, Daniela Schoene1, Eyad Altarsha1

  • 1Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.

Journal of Critical Care
|March 26, 2021
PubMed
Abstract

Insights

Mannitol use in malignant middle cerebral artery infarction patients is linked to higher rates of acute kidney injury (AKI) and dialysis needs. Clinicians should carefully consider routine mannitol administration due to these risks.

Area of Science:

  • Nephrology
  • Neurology
  • Critical Care Medicine

Background:

  • Malignant middle cerebral artery (MCA) infarction is a severe neurological condition.
  • Hyperosmolar therapy, including mannitol, is sometimes used in managing intracranial pressure.
  • The kidney safety profile of mannitol in this specific patient population requires thorough assessment.

Purpose of the Study:

  • To evaluate the incidence of acute kidney injury (AKI) and need for dialysis in patients with malignant MCA infarction treated with mannitol.
  • To identify mannitol as a potential predictor of AKI in this cohort.

Main Methods:

  • Retrospective analysis of 219 patients with malignant MCA infarction from 2008-2018.
  • Comparison of clinical outcomes, including AKI (KDIGO criteria) and dialysis, between patients who received mannitol and those who did not.
  • Multivariable logistic regression to identify predictors of AKI and in-hospital death.

Main Results:

  • Mannitol was administered to 42.5% of patients (average dose 650g).
  • Patients receiving mannitol had significantly higher rates of AKI (39.8% vs. 11.9%) and required hemodialysis (7.5% vs. 0.8%).
  • Mannitol was an independent predictor of AKI (OR 5.02), with higher persistent AKI rates at discharge in the mannitol group (23.7% vs. 6.4%).

Conclusions:

  • Acute kidney injury is a frequent complication associated with mannitol use in malignant MCA infarction.
  • The effectiveness of mannitol in this patient group is not well-established.
  • Routine use of mannitol in malignant MCA infarction warrants careful consideration due to potential nephrotoxicity.
Keywords:
Acute kidney injuryHyperosmolar therapyIntracranial pressureLarge hemispheric stroke

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