• Haidar Moustafa, Daniela Schoene, Eyad Altarsha, Jan Rahmig, Hauke Schneider, Lars-Peder Pallesen, Alexandra Prakapenia, Timo Siepmann, Jessica Barlinn, Jens Passauer, Heinz Reichmann, Volker Puetz, and Kristian Barlinn.
• Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
• J Crit Care. 2021 Aug 1; 64: 22-28.

PurposeTo assess the kidney safety profile of mannitol in patients with malignant middle cerebral artery (MCA) infarction.Material And MethodsWe studied consecutive patients with malignant MCA infarction (01/2008-01/2018). Malignant MCA infarction was defined according to DESTINY criteria. We compared clinical endpoints including acute kidney injury (AKI; according to Kidney Disease: Improving Global Outcomes [KDIGO]) and dialysis between patients with and without mannitol. Multivariable model was built to explore predictor variables of AKI and in-hospital death.ResultsOverall, 219 patients with malignant MCA infarction were included. Mannitol was administered in 93/219 (42.5%) patients with an average dosage of 650 g (250-950 g). Patients treated with mannitol more frequently suffered from AKI (39.8% vs. 11.9%; p < 0.001) and required hemodialysis (7.5% vs. 0.8%; p = 0.01) than patients without mannitol. At discharge, more patients in the mannitol group had persistent AKI than control patients (23.7% vs. 6.4%, p < 0.001). In multivariable model, mannitol emerged as independent predictor of AKI (OR 5.02, 95%CI 2.36-10.69; p < 0.001).ConclusionsAcute kidney injury appears to be a frequent complication of hyperosmolar therapy with mannitol in patients with malignant MCA infarction. Given the lack of evidence supporting effectiveness of mannitol in these patients, its routine use should be carefully considered.Copyright © 2021 Elsevier Inc. All rights reserved.

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