Abstract P687: Acute Kidney Failure in Patients With Malignant Middle Cerebral Artery Infarction Undergoing Osmotherapy With Mannitol

Abstract

Introduction: To explore kidney safety profile of osmotic diuretic mannitol in patients with malignant middle cerebral artery (MCA) infarction. Methods: We analyzed data from consecutive patients with malignant MCA infarction (01/2008-12/2017). Malignant MCA infarction was defined according to clinical and radiographic DESTINY criteria. Clinical and laboratory variables were collected for all patients. We compared clinical endpoints including acute kidney failure (AKF; according to Kidney Disease: Improving Global Outcomes [KDIGO] definition) and hemodialysis between patients who received mannitol and those who did not. Multivariable model was built to explore predictor variables of AKF, in-hospital death and functional outcome at discharge. Results: Overall, 228 patients with malignant MCA infarction were analyzed: median age 67 years (IQR, 56-76), 58% men, median NIHSS 23 (17-32) points. Decompressive craniectomy was performed in 103/228 (45.2%) patients. Mannitol was administered in 100/228 (43.9%) patients over an average of 85 (30.3-139.3) hours. Average dosage was 700 (250-1050) g. Patients treated with mannitol more frequently suffered from AKF (40% vs. 7.9%; p<0.0001) and needed hemodialysis (7.4% vs. 0.9%; p=0.024) than patients without mannitol. At discharge, kidney function completely recovered in 38.5% and 20%, respectively (p=0.459). In multivariable model adjusted for age, history of chronic kidney disease, nephrotoxic premedication, admission systolic blood pressure, concurrent urinary tract infection, contrast agent exposure and peak osmolality, mannitol therapy emerged as single predictor of AKF (OR 4.14, 95%CI 1.2-14.2; p=0.024). Neither AKF nor mannitol therapy was associated with in-hospital death or short-term functional outcome (p>0.05). Conclusions: Acute kidney failure appears to be a frequent complication of osmotic diuretic mannitol in patients with malignant MCA infarction. Given the lack of evidence supporting effectiveness of mannitol in these patients, its use should be carefully considered.