title: Mannitol and renal dysfunction after endovascular aortic aneurysm repair procedures: a randomized trial.
abstract: OBJECTIVE
  Endovascular aortic aneurysm repair (EVAR) may result in deterioration of renal function. Mannitol has renovascular and antioxidant properties that could prove beneficial in this respect.
  
  
  METHODS
  A randomized prospective study.
  
  
  METHODS
  Attikon University Hospital, single institution.
  
  
  METHODS
  Eighty-six patients undergoing elective EVAR under regional anesthesia.
  
  
  METHODS
  Patients received hydration alone (controls) or hydration plus mannitol (0.5 g/kg).
  
  
  RESULTS
  Creatinine, serum cystatin-C, urine neutrophil-gelatinase-associated lipocalin (NGAL), albuminuria and serum urea were measured 24 hours and 72 hours after the procedure (baseline NGAL was measured in 19 randomly selected patients). Serum creatinine also was measured at the followup of the patients. Serum creatinine and cystatin-C were lower in the mannitol group at 24 hours postoperatively (creatinine, mannitol [n=43]; 1.07±0.26 [CI95%: 0.99-1.15] v controls [n=43]; 1.20±0.30 [CI95%: 1.11-1.30]), but not at 72 hours (creatinine, mannitol [n=43]; 1.13±0.29 [CI95%: 1.04-1.22] v controls [n=43]; 1.26±0.41 [CI95% 1.15-1.38]). Urine NGAL increased substantially at 24 hours without differences between groups. At followup (controls: 13±7 months; mannitol: 12±7 months), there were no differences between creatinine or creatinine clearance (creatinine: controls [n=28]; 1.15±0.39 [CI95% 1.02-1.29] v mannitol [n=23]; 1.05±0.27 [CI95%: 0.95-1.17]). The overall changes of creatinine and creatinine clearance with time were significant in controls but not in the mannitol group. The classification according to the RIFLE criteria yielded 4 patients at risk for renal injury and 2 with renal injury in the control group and 6 patients at risk with no patients with injury in the mannitol group, but the difference of renal dysfunction between the 2 groups was not statistically significant.
  
  
  CONCLUSIONS
  Mannitol plus hydration during EVAR provides a small but significant benefit for renal function. Future preventive protocols aiming at greater restoration of renal function after EVAR could include mannitol as a useful component.
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Konstantinos
authors: K
authors: Kalimeris
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Nikolaos
authors: N
authors: Nikolakopoulos
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Maria
authors: M
authors: Riga
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Kalliopi
authors: K
authors: Christodoulaki
authors: Department of Vascular Surgery, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Konstantinos G
authors: KG
authors: Moulakakis
authors: 2nd Department of Clinical Biochemistry, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Cleanthi
authors: C
authors: Dima
authors: Department of Vascular Surgery, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Christos
authors: C
authors: Papasideris
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Tatiana
authors: T
authors: Sidiropoulou
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece.
authors: Georgia
authors: G
authors: Kostopanagiotou
authors: 2nd Department of Anesthesiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece. Electronic address: angpant@med.uoa.gr.
authors: Angeliki
authors: A
authors: Pandazi
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D004234:Diuretics, Osmotic / Q000008:administration & dosage; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D055316:Cystatin C; D004234:Diuretics, Osmotic; D008353:Mannitol; D003404:Creatinine
keywords: acute kidney injury; endovascular aneurysm repair (EVAR); mannitol; renal function