Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage.
OBJECTIVE
Mannitol, an osmotic agent used to decrease intracranial pressure, can cause acute kidney injury (AKI). The objectives of this study were to assess the impact of mannitol on the incidence and severity of AKI and to identify risk factors and outcome for AKI in patients with intracranial hemorrhage (ICH).


METHODS
The authors retrospectively evaluated 153 adult patients who received mannitol infusion after ICH between January 2005 and December 2009 in the neurosurgical intensive care unit. Multivariate analysis was used to evaluate the risk factors for AKI after ICH. Based on the odds ratio, weighted scores were assigned to predictors of AKI.


RESULTS
The overall incidence of AKI among study participants was 10.5% (n = 16). Acute kidney injury occurred more frequently in patients who received mannitol infusion at a rate ≥ 1.34 g/kg/day than it did in patients who received mannitol infusion at a rate < 1.34 g/kg/day. A higher mannitol infusion rate was associated with more severe AKI. Independent risk factors for AKI were mannitol infusion rate ≥ 1.34 g/kg/day, age ≥ 70 years, diastolic blood pressure (DBP) ≥ 110 mm Hg, and glomerular filtration rate < 60 ml/min/1.73 m(2). The authors developed a risk model for AKI, wherein patients with a higher risk score showed a graded association with a higher incidence of AKI.


CONCLUSIONS
The incidence of AKI following mannitol infusion in patients with ICH was 10.5%. A higher mannitol infusion rate was associated with more frequent and more severe AKI. Additionally, age ≥ 70 years, DBP ≥ 110 mm Hg, and established renal dysfunction before starting mannitol therapy were associated with development of AKI.
Department of Internal Medicine, Seoul Medical Center; and.
Min Young
MY
Kim
Ji Hyeon
JH
Park
Na Ree
NR
Kang
Hye Ryoun
HR
Jang
Jung Eun
JE
Lee
Wooseong
W
Huh
Yoon-Goo
YG
Kim
Dae Joong
DJ
Kim
Seung-Chyul
SC
Hong
Jong-Soo
JS
Kim
Ha Young
HY
Oh
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000503:physiopathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D008353:Mannitol
AKI = acute kidney injury; AKIN = Acute Kidney Injury Network; AUC = area under the curve; DBP = diastolic blood pressure; GFR = glomerular filtration rate; ICH = intracranial hemorrhage; ICP = intracranial pressure; IQR = interquartile range; ROC = receiver operating characteristic; SBP = systolic blood pressure; acute kidney injury; intracranial hemorrhage; mannitol; vascular disorders