Incidence and Risk Factors for Acute Kidney Injury Following Mannitol Infusion in Patients With Acute Stroke

Abstract

Mannitol, an osmotic diuretic, is commonly used to treat patients with acute brain edema, but its use also increases the risk of developing acute kidney injury (AKI). In this study, we investigated the incidence and risk factors of mannitol-related AKI in acute stroke patients.A total of 432 patients (ischemic stroke 62.3%) >20 years of age who were admitted to the neurocritical care center in a tertiary hospital and received mannitol treatment were enrolled in this study. Clinical parameters including the scores of National Institutes of Health Stroke Scale (NIHSS) at admission, vascular risk factors, laboratory data, and concurrent nephrotoxic medications were registered. Acute kidney injury was defined as an absolute elevation in the serum creatinine (Scr) level of ≥0.3 mg/dL from the baseline or a ≥50% increase in Scr.The incidence of mannitol-related AKI was 6.5% (95% confidence interval, 4.5%–9.3%) in acute stroke patients, 6.3% in patients with ischemic stroke, and 6.7% in patients with intracerebral hemorrhage. Multivariate analysis revealed that diabetes, lower estimated glomerular filtration rate at baseline, higher initial NIHSS score, and concurrent use of diuretics increased the risk of mannitol-related AKI. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.839 (95% confidence interval, 0.770–0.909). In conclusion, mannitol-related AKI is not uncommon in the treatment of acute stroke patients, especially in those with vulnerable risk factors.

Incidence, Risk factors, and Biomarkers Predicting Ischemic or Hemorrhagic Stroke Associated Acute Kidney Injury and Outcome: A Retrospective Study in a General Intensive Care Unit

“…The present study is in accordance with this. Finally, according to previous studies [15,16,36], AKI was significantly associated with an increased risk of mortality in patients with stroke, but in the present analysis, AKI was not an independent risk factor for adverse short-term outcomes.…”

“…High NIHSS and APACHE II scores at ICU admission reflected the severity of illness. A retrospective study [36] AKI, acute kidney injury; CKD, chronic kidney disease; NIHSS, National Institutes of Health Stroke Scale; GCS, Glasgow Coma Scale; APACHE II, acute physiology and chronic health evaluation; sCr, serum creatinine; sCysC, serum cystatin C; β2-MG, β2-microglobulin; eGFR, estimated glomerular fltration rate; BUN, blood urea nitrogen. showed that high NIHSS score, low baseline eGFR, and hypertension were risk factors for AKI in stroke patients admitted to the Neurology ICU, and this was verified in the present multivariate analysis.…”

Clinical effects of joint application of β-sodium aescinate and mannitol in treating early swelling after upper limb trauma surgery

“…Currently, the treatment of choice for swelling is primarily mannitol, lactulose and diuretics. However, mannitol may cause acute kidney injury (2), lactulose can cause the metabolism of blood sugar and electrolyte (3) and the effects of diuretics for local inflammatory edema are poor (4). …”

Дискусійні Питання Застосування Манітолу У Хворих На Гострий Інсульт (Огляд Літератури Й Власний Досвід)

“…У випадках, коли є затримка рідини в організмі й порушення фільтрації в нирках, побіч-ні ефекти манітолу можуть переважити діуретичний ефект. Особливо небезпечне застосування манітолу в пацієнтів, які страждають від хронічної ниркової недостатності й застійної серцевої недостатності: гостра гіперволемія може призвести до декомпенса-ції серцевої діяльності й набряку легень [7,15].…”