Moving away from mannitol infusion for partial nephrectomy: has this altered renal function?

Area of Science:

• Nephrology
• Urology
• Surgical Oncology

Background:

• Mannitol infusion was historically used to protect kidneys during partial nephrectomy.
• Recent evidence questions the renal-protective benefits of mannitol in this context.

Purpose of the Study:

• To evaluate the impact of discontinuing routine mannitol administration on renal function after partial nephrectomy.
• To determine if mannitol use is associated with de novo stage III chronic kidney disease (CKD III) or changes in estimated glomerular filtration rate (eGFR).

Main Methods:

• Retrospective review of a multi-institution database of 915 patients undergoing partial nephrectomy.
• Comparison of renal function outcomes (CKD III, eGFR) between patients who received mannitol and those who did not.
• Statistical analysis including Mann-Whitney-U, Chi-squared tests, and mixed-effects linear regression models.

Main Results:

• No significant differences in baseline demographics or perioperative characteristics between groups.
• Mannitol use was associated with a higher incidence of de novo CKD III (14% vs. 9%, p=0.041).
• Mannitol use was linked to a minimally worse median eGFR at final follow-up (72.82 vs. 76.06, p=0.039) and potentially longer operative/ischemia times.

Conclusions:

• Mannitol administration during partial nephrectomy likely offers no short- or long-term renal benefit.
• Discontinuation of routine mannitol may be considered, as its use may be detrimental if it prolongs surgical or ischemia time.