title: Incidence and Risk Factors for Acute Kidney Injury Following Mannitol Infusion in Patients With Acute Stroke: A Retrospective Cohort Study.
abstract: Mannitol, an osmotic diuretic, is commonly used to treat patients with acute brain edema, but its use also increases the risk of developing acute kidney injury (AKI). In this study, we investigated the incidence and risk factors of mannitol-related AKI in acute stroke patients.A total of 432 patients (ischemic stroke 62.3%) >20 years of age who were admitted to the neurocritical care center in a tertiary hospital and received mannitol treatment were enrolled in this study. Clinical parameters including the scores of National Institutes of Health Stroke Scale (NIHSS) at admission, vascular risk factors, laboratory data, and concurrent nephrotoxic medications were registered. Acute kidney injury was defined as an absolute elevation in the serum creatinine (Scr) level of ≥0.3 mg/dL from the baseline or a ≥50% increase in Scr.The incidence of mannitol-related AKI was 6.5% (95% confidence interval, 4.5%-9.3%) in acute stroke patients, 6.3% in patients with ischemic stroke, and 6.7% in patients with intracerebral hemorrhage. Multivariate analysis revealed that diabetes, lower estimated glomerular filtration rate at baseline, higher initial NIHSS score, and concurrent use of diuretics increased the risk of mannitol-related AKI. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.839 (95% confidence interval, 0.770-0.909). In conclusion, mannitol-related AKI is not uncommon in the treatment of acute stroke patients, especially in those with vulnerable risk factors.
authors.affiliation: From the Department of Pharmacy, National Taiwan University Hospital (L-SY, S-LJ, W-FLL); School of Pharmacy, College of Pharmacy, National Taiwan University (L-SY, S-LJ, W-FLL); Stroke Center and Department of Neurology, National Taiwan University Hospital (T-SC, T-LK, Y-SJ, J-JS); and Graduate Institute of Clinical Pharmacy, College of Pharmacy, National Taiwan University, Taipei, Taiwan (S-LJ, W-FLL).
authors.forename: Shin-Yi
authors.initials: SY
authors.lastname: Lin
authors.forename: Sung-Chun
authors.initials: SC
authors.lastname: Tang
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: Tsai
authors.forename: Shin-Joe
authors.initials: SJ
authors.lastname: Yeh
authors.forename: Li-Jiuan
authors.initials: LJ
authors.lastname: Shen
authors.forename: Fe-Lin Lin
authors.initials: FL
authors.lastname: Wu
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004234:Diuretics, Osmotic / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol