EURURO Vol. 73 No. 1

Platinum Priority

–

Kidney Cancer

Editorial by Paras H. Shah, Bradley C. Leibovich and Timothy D. Lyon on pp. 60

–

61 of this issue

Intravenous Mannitol Versus Placebo During Partial Nephrectomy

in Patients with Normal Kidney Function: A Double-blind,

Clinically-integrated, Randomized Trial

Massimiliano Spaliviero

a , y

[1_TD$DIFF]

, Nicholas E. Power b , y

[1_TD$DIFF]

, Katie S. Murray a , Daniel D. Sjoberg c ,

Nicole E. Benfante

a , Melanie L. Bernstein a , James Wren a , Paul Russo a , Jonathan A. Coleman a , *

Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA;

Department of Surgery, Division of Urology, Western

University, London, ON, Canada;

Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

E U R O P E A N U R O L O GY 7 3 ( 2 0 18 ) 5 3 – 5 9

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted July 28, 2017

Associate Editor:

Stephen Boorjian

Keywords:

Mannitol

Partial nephrectomy

Renal function

Nephron-sparing surgery

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Abstract

Background:

Mannitol is currently used as a renal protective agent to mitigate the

effects of renal ischemia during nephron-sparing surgery (NSS). This routine practice

lacks rigorous methodological study.

Objective:

To assess the effect on renal function outcomes after surgery of mannitol

infusion prior to renal ischemia during NSS.

Design, setting, participants:

This prospective, randomized, placebo-controlled, double-

blind trial included 199 patients with a preoperative estimated glomerular

ltration rate

(eGFR)

45 ml/min/1.73m

[1_TD$DIFF]

scheduled for NSS; the trial was conducted between July

2012 and July 2015.

Intervention:

Patients undergoing NSS were randomized to receive mannitol (12.5 g) or

placebo intravenously within 30 min prior to renal vascular clamping.

Outcome measurements and statistical analysis:

The primary outcome was the differ-

ence in eGFR (renal function) between the two groups at 6 mo following surgery

assessed with an analysis of covariance model using preoperative eGFR, treatment

group, and surgical approach as covariates.

Results and limitations:

At baseline, the median age of the patients was 58 yr, and the

median eGFR was 88 ml/min/1.73m

. Comparing placebo with mannitol infusion, the

adjusted difference of 0.2 eGFR units at 6 mo was not signi

cant (

= 0.9), with the upper

bound of the 95% con

dence interval (

–

3.1 to 3.5) excluding a clinically relevant effect of

mannitol. Limitations include evaluation of a single mannitol dose and patients all had

excellent preoperative renal function.

Conclusions:

Intraoperative 12.5 g mannitol infusion during NSS has no demonstrable

clinical bene

t when compared with standardized

uid hydration in patients with

normal preoperative renal function, and its use in this setting is not warranted.

Patient summary:

In this randomized trial, patients with normal kidney function who

received mannitol during surgery to remove part of their kidney had no better kidney

function 6 mo after surgery than those who did not receive mannitol. We conclude that

this routine practice should be discontinued.

These authors contributed equally to this work.

* Corresponding author. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer

Center, 1275 York Avenue, New York, NY 10065, USA. Tel. +1 646 422 4432; Fax: +1 212 452 3323.

E-mail address:

colemanj@mskcc.org

(J.A. Coleman).

http://dx.doi.org/10.1016/j.eururo.2017.07.038