Intravascular administration of mannitol for acute kidney injury prevention: a systematic review and meta-analysis.
BACKGROUND
The effects of mannitol administration on acute kidney injury (AKI) prevention remain uncertain, as the results from clinical studies were conflicting. Due to the lack of strong evidence, the KDIGO Guideline for AKI did not propose completely evidence-based recommendations on this issue.


METHODS
We searched PubMed, EMBASE, clinicaltrials.gov and Cochrane Controlled Trials Register. Randomized controlled trials on adult patients at increased risk of AKI were considered on the condition that they compared the effects of intravascular administration of mannitol plus expansion of intravascular volume with expansion of intravascular volume alone. We calculated pooled risk ratios, numbers needed to treat and mean differences with 95% confidence intervals for dichotomous data and continuous data, respectively.


RESULTS
Nine trials involving 626 patients were identified. Compared with expansion of intravascular volume alone, mannitol infusion for AKI prevention in high-risk patients can not reduce the serum creatinine level (MD 1.63, 95% CI -6.02 to 9.28). Subgroup analyses demonstrated that serum creatinine level is negatively affected by the use of mannitol in patients undergoing an injection of radiocontrast agents (MD 17.90, 95% CI 8.56 to 27.24). Mannitol administration may reduce the incidence of acute renal failure or the need of dialysis in recipients of renal transplantation (RR 0.34, 95% CI 0.21 to 0.57, NNT 3.03, 95% CI 2.17 to 5.00). But similar effects were not found in patients at high AKI risk, without receiving renal transplantation (RR 0.29, 95% CI 0.01 to 6.60).


CONCLUSIONS
Intravascular administration of mannitol does not convey additional beneficial effects beyond adequate hydration in the patients at increased risk of AKI. For contrast-induced nephropathy, the use of mannitol is even detrimental. Further research evaluating the efficiency of mannitol infusions in the recipients of renal allograft should be undertaken.
Kidney Institute of Chinese People's Liberation Army, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Bo
B
Yang
Kidney Institute of Chinese People's Liberation Army, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Jing
J
Xu
Division of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Fengying
F
Xu
Division of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Zui
Z
Zou
Kidney Institute of Chinese People's Liberation Army, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Chaoyang
C
Ye
Kidney Institute of Chinese People's Liberation Army, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Changlin
C
Mei
Kidney Institute of Chinese People's Liberation Army, Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Zhiguo
Z
Mao
D058186:Acute Kidney Injury / Q000097:blood / Q000517:prevention & control* / Q000628:therapy / Q000652:urine; D001808:Blood Vessels; D006801:Humans; D008353:Mannitol / Q000008:administration & dosage*; D006435:Renal Dialysis
D008353:Mannitol