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

Published on Feb 26, 2021in Journal of Critical Care2.685
· DOI :10.1016/J.JCRC.2021.02.007
Haidar Moustafa4
Estimated H-index: 4
(TUD: Dresden University of Technology),
Daniela Schoene (TUD: Dresden University of Technology)+ 10 AuthorsKristian Barlinn21
Estimated H-index: 21
(TUD: Dresden University of Technology)
Sources
Abstract
Abstract Purpose To assess the kidney safety profile of mannitol in patients with malignant middle cerebral artery (MCA) infarction. Material and methods We studied consecutive patients with malignant MCA infarction (01/2008–01/2018). Malignant MCA infarction was defined according to DESTINY criteria. We compared clinical endpoints including acute kidney injury (AKI; according to Kidney Disease: Improving Global Outcomes [KDIGO]) and dialysis between patients with and without mannitol. Multivariable model was built to explore predictor variables of AKI and in-hospital death. Results Overall, 219 patients with malignant MCA infarction were included. Mannitol was administered in 93/219 (42.5%) patients with an average dosage of 650 g (250-950 g). Patients treated with mannitol more frequently suffered from AKI (39.8% vs. 11.9%; p  Conclusions Acute kidney injury appears to be a frequent complication of hyperosmolar therapy with mannitol in patients with malignant MCA infarction. Given the lack of evidence supporting effectiveness of mannitol in these patients, its routine use should be carefully considered.
📖 Papers frequently viewed together
References30
Newest
#1Hendrik Reinink (UU: Utrecht University)H-Index: 3
#2Eric Jüttler (University Hospital Heidelberg)H-Index: 3
Last. Hermann Neugebauer (University of Würzburg)H-Index: 15
view all 15 authors...
Importance In patients with space-occupying hemispheric infarction, surgical decompression reduces the risk of death and increases the chance of a favorable outcome. Uncertainties, however, still remain about the benefit of this treatment for specific patient groups. Objective To assess whether surgical decompression for space-occupying hemispheric infarction is associated with a reduced risk of death and an increased chance of favorable outcomes, as well as whether this association is modified ...
7 CitationsSource
#1Andrew S. Levey (Tufts Medical Center)H-Index: 165
#2Kai-Uwe Eckardt (Charité)H-Index: 105
Last. Wolfgang C. Winkelmayer (BCM: Baylor College of Medicine)H-Index: 74
view all 7 authors...
The worldwide burden of kidney disease is rising, but public awareness remains limited, underscoring the need for more effective communication by stakeholders in the kidney health community. Despite this need for clarity, the nomenclature for describing kidney function and disease lacks uniformity. In June 2019, Kidney Disease: Improving Global Outcomes (KDIGO) convened a consensus conference with the goal of standardizing and refining the nomenclature used in the English language to describe ki...
8 CitationsSource
#1Raleigh M. Linville (Johns Hopkins University)H-Index: 11
#2Jackson G. DeStefano (Johns Hopkins University)H-Index: 9
Last. Peter C. Searson (Johns Hopkins University)H-Index: 86
view all 6 authors...
As the majority of therapeutic agents do not cross the blood–brain barrier (BBB), transient BBB opening (BBBO) is one strategy to enable delivery into the brain for effective treatment of CNS disea...
18 CitationsSource
#1Matthew J. Rowland (University of Oxford)H-Index: 14
#2Tonny Veenith (University of Birmingham)H-Index: 14
Last. Sos Trial InvestigatorsH-Index: 1
view all 5 authors...
3 CitationsSource
#1Li JieH-Index: 1
#2Ping ZhangH-Index: 3
Last. Chun WangH-Index: 4
view all 7 authors...
Objective:Neurological and medical complications are major causes of morbidity and mortality after ischemic stroke. This study aimed to identify the incidence of stroke-related complications follow...
7 CitationsSource
#1David S Liebeskind (UCLA: University of California, Los Angeles)H-Index: 84
#2Eric Jüttler (University of Ulm)H-Index: 29
Last. Edward C. JauchH-Index: 66
view all 6 authors...
19 CitationsSource
#1Hermann Neugebauer (University of Ulm)H-Index: 15
#2Hauke Schneider (TUD: Dresden University of Technology)H-Index: 16
Last. Eric Jüttler (University of Ulm)H-Index: 29
view all 14 authors...
Importance Moderate hypothermia in addition to early decompressive hemicraniectomy has been suggested to further reduce mortality and improve functional outcome in patients with malignant middle cerebral artery (MCA) stroke. Objective To investigate whether moderate hypothermia vs standard treatment after early hemicraniectomy reduces mortality at day 14 in patients with malignant MCA stroke. Design, Setting, and Participants This randomized clinical trial recruited patients from August 2011 thr...
26 CitationsSource
#1Sebastian J. Klein (Innsbruck Medical University)H-Index: 9
#2Georg F. LehnerH-Index: 8
Last. Michael JoannidisH-Index: 40
view all 4 authors...
Oliguria is often observed in critically ill patients. However, different thresholds in urine output (UO) have raised discussion as to the clinical importance of a transiently reduced UO of less than 0.5 ml/kg/h lasting for at least 6 h. While some studies have demonstrated that isolated oliguria without a concomitant increase in serum creatinine is associated with higher mortality rates, different underlying pathophysiological mechanisms suggest varied clinical importance of reduced UO, as some...
15 CitationsSource
#1Marianthi Papagianni (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 6
#2Konstantinos Tziomalos (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 57
Last. Apostolos I. Hatzitolios (A.U.Th.: Aristotle University of Thessaloniki)H-Index: 29
view all 10 authors...
Background Current guidelines state that osmotic therapy is reasonable in patients with clinical deterioration from cerebral infarction-related cerebral edema. However, there are limited data on the safety and efficacy of this therapy. We aimed to evaluate the effect of mannitol on the outcome of ischemic stroke-related cerebral edema.
4 CitationsSource
#1Jinwan Shi (STU: Shantou University)H-Index: 1
#2Jiuzhan Qian (STU: Shantou University)H-Index: 1
Last. Zhexuan Lin (STU: Shantou University)H-Index: 8
view all 6 authors...
Administration of mannitol with high dose could induce extensive isometric renal proximal tubular vacuolization and acute renal failure in clinic. We previously demonstrated that mannitol-induced human kidney tubular epithelial cell (HK-2) injury. The objective of our present work was to further study the cytotoxicity of mannitol in HK-2 cells and its potential mechanism. Cell viability was assessed by an MTT method. Cell morphological changes were observed. Furthermore, levels of malondialdehyd...
10 CitationsSource
Cited By2
Newest
#1Patrick M. HonoreH-Index: 19
#2Sebastien RedantH-Index: 6
Last. David De BelsH-Index: 16
view all 9 authors...
Source
#1Wojciech Dabrowski (Medical University of Lublin)H-Index: 13
#2Dorota Siwicka-Gieroba (Medical University of Lublin)H-Index: 6
Last. Rafael Badenes (University of Valencia)H-Index: 15
view all 10 authors...
Hyperosmotic therapy is commonly used to treat intracranial hypertension in traumatic brain injury patients. Unfortunately, hyperosmolality also affects other organs. An increase in plasma osmolality may impair kidney, cardiac, and immune function, and increase blood–brain barrier permeability. These effects are related not only to the type of hyperosmotic agents, but also to the level of hyperosmolality. The commonly recommended osmolality of 320 mOsm/kg H2O seems to be the maximum level, altho...
Source