Division of Urology at Mount Sinai Medical Center, Columbia University, Miami Beach, FL, USA.
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Robot Surg. 2023 Feb;17(1):43-48. doi: 10.1007/s11701-022-01397-7. Epub 2022 Mar 17.
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.
近年来，研究对部分肾切除术期间甘露醇输注的理论肾保护价值提出了质疑。本研究探讨了在当代，停止常规甘露醇给药是否对患者有益或有害。我们回顾性地分析了一个多机构数据库，以确定甘露醇给药与随访期间肾功能之间的关联。这些患者被评估为新发 III 期慢性肾脏病（CKD III），并通过估算肾小球滤过率（eGFR）进行随访。统计分析包括 Mann-Whitney-U 和 Chi-squared 检验，用于比较基线和围手术期变量与术后结果。eGFR 变化采用混合效应线性回归模型进行评估。确定了 915 名患者，其手术报告或外科医生的治疗方案明确描述了是否给予甘露醇。667 名（73%）患者未给予甘露醇。从甘露醇使用者和未使用者的人口统计学、年龄、Charlson 合并症指数、肾切除术评分、肿瘤大小、分级或基线 eGFR 来看，两组之间没有差异。甘露醇使用组的缺血时间和手术时间似乎略长。患者中位随访时间为 5 个月（IQR 0.5-19 个月），在此期间，甘露醇的使用与新发 CKD III 的增加相关（14%比 9%，p=0.041），最终随访时 eGFR 的中位数也略有恶化（72.82 比 76.06，p=0.039）。我们对部分肾切除术患者的分析表明，甘露醇给药可能不会带来短期或长期的肾脏益处。甘露醇可由外科医生酌情使用，但如果它延长手术时间或缺血时间，实际上可能对结果有害。
