Phase 3 Randomised Trial of Intravenous Mannitol Versus Placebo During Nephron-Sparing Surgery: Impact on Renal Function Outcomes

Boston, MA (UroToday.com) A group from Memorial Sloan Kettering completed a phase III trial evaluating the impact of administering mannitol prior to renal ischemia on functional outcomes for partial nephrectomy. Mannitol has long been considered a renoprotective agent that reduces the overall renal function loss following nephron sparing surgery; however, no placebo-controlled randomized clinical trial in humans has ever been performed.

Among 81 patients, no difference in patients that received placebo (n=41) or mannitol (n=40) was found with respect to GFR at 6 months. Furthermore, no difference in estimated blood loss, clamping time, and renal function scan at 6 months was reported. Thus, no identifiable evidence of preservation of renal function was observed with mannitol and its use may no longer be necessary.

During the presentation, Dr. Spaliviero made an excellent observation; not only to highlight the significance of their negative results, but also the debunking of mannitol use has paved exploration for different renoprotective agents that may be use intraoperatively during nephron sparing surgery. Interestingly, mannitol has also been suggested to potentiate ischemia during partial nephrectomy by selectively increasing renal cortical blood flow and metabolic demand.

Presented by: Dr. Massimiliano Spaliviero, MD

Authors: Wen Dong, Jitao Wu, Chalairat Suk-Ouichai, Elvis Carabello, Diego Aguilar Palacios, Erick Remer, Jianbo Li, Joseph Zabell, Sudhir Isharwal, Steven Campbell,

Affiliation: Cleveland Clinic, Cleveland, OH

Written By: Daniel Lama for UroToday.com

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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