Mannitol Use Is Renal Protective in Patients With Chronic Kidney Disease Requiring Suprarenal Aortic Clamping

Mannitol is often administered during open juxtarenal or suprarenal aortic surgery to prevent ischemic injury the kidneys. Prior evidence evaluating benefits of intraoperative mannitol in reducing ischemia/reperfusion conflicting and largely based on small, retrospective series. The aim this study was evaluate effect preventing postoperative hemodialysis patients undergoing abdominal aneurysm (AAA) repair where proximal control involved temporary renal ischemia. Society for Vascular Surgery Quality Initiative database queried all elective AAA between 2003 2020. Patients were included current analysis if clamp placed above at least one artery. Chronic kidney disease (CKD) defined as Cr >1.8. Primary end points 30-day major morbidity (myocardial infarction, respiratory complications, lower extremity intestinal ischemia, need permanent hemodialysis) mortality. Comparisons made nonmannitol cohorts stratified by presence pre-existing CKD. During period, 4156 underwent requiring unilateral (32.7%) bilateral (67.3%) ischemia; 182 (4.4%) had Overall, 69.8% received their surgery. more frequently used cases with ischemia (70.3%) than (61.5%). Although prolonged time (greater 40 minutes) associated higher risk dialysis without CKD, it not significant baseline On univariate analysis, use CKD (P = .005). This remained multivariate .008). did appear confer protective effects a decreased (Cr >1.8) clamping repair. In appropriately selected patients, particularly those underlying insufficiency, may pararenal clamping.TableNeed HD with/without analysis95% confidence intervalHazard ratioP valueWith Age >70 years0.872-1.5571.165.301 Current smoking0.450-1.4810.816.504 CHF0.435-5.9861.614.479 P2Y120.704-17.7783.539.125 Mannitol0.078-0.6840.230.008Without years0.925-1.2061.056.420 Smoking1.016-1.6901.310.037 CHF0.659-2.8881.379.394 P2Y0.471-2.1721.011.977 Mannitol0.756-2.2931.316.332 CAD0.520-1.5690.903.718 COPD0.684-1.8761.133.629 HTN0.585-3.4461.420.439 DM1.199-3.4592.036.009 Statin0.830-3.0551.592.161 Ischemia >40 minutes2.005-5.3073.262.000 pRBCs >4 u1.811-5.1953.067.000Boldface P values represent statistical significance. Open table new tab