Category: Clinical Oncology: Outcomes & Complications

MP18-6 - Intraoperative mannitol during partial nephrectomy does not benefit patients with diminished renal functional reserve at baseline

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : To assess if intraoperative mannitol during partial nephrectomy (PN) provides clinical benefit to patients with impaired kidney function at baseline (eGFR< 60 mL/min/1.73 m²).


Methods : A retrospective analysis was performed using an institutional renal cancer database. Patients were divided into 2 groups: mannitol (+) eGFR < 60 and mannitol (-) eGFR < 60. Patients with baseline eGFR > 60 and those lacking at least one follow-up (f/u) creatinine measurement were excluded. The outcomes measured were eGFR change and CKD upstaging at two postoperative f/u times. Covariates in this study included first and second f/u periods (weeks), ischemia time (minutes), blood loss (ml), intravenous fluids given (ml), tumor size (cm), and age (years). Mann-Whitney U tests were used to determine if eGFR changes and covariates differed amongst groups. Differences in CKD upstaging were evaluated with chi-squared analysis.


Results : 157 total patients had sufficient f/u of which 24 had a baseline eGFR < 60 (CKD III-V) and met inclusion criteria. The average eGFR of these patients was 51.28 (12.48) (median and IQR). 13 patients received intraoperative mannitol during PN and 11 did not. (Table 1) Covariates did not differ amongst the two groups. The average change in eGFR for the mannitol (+) and (-) groups were 0 (13) and 5.45 (6.23) respectively at first f/u. (p = 0.4616).  At second f/u, the average change in eGFR for the mannitol (+) and (-) groups was 10.75 (9.98) and 6.85 (11.81) respectively. (p = 0.3710) CKD upstaging also did not differ amongst the two groups at both first and second f/u visits. (p = 0.1243 and 0.7897 respectively) (Table 2)


Conclusions :

Our preliminary data suggests that intraoperative mannitol provides no added benefit to the majority of PN patients with baseline eGFR < 60 (CKD III-V disease).

Saikrishnaraya Doppalapudi

Medical Student
Rutgers - New Jersey Medical School
Plainsboro, New Jersey

Jessica A. Connor

Medical student
Rutgers - New Jersey Medical School
Ridgewood, New Jersey

Thaiphi Luu

Medical Student
Rutgers - New Jersey Medical School
Cedar Brook, New Jersey

Thaiphi Luu, 4th year medical student, Rutgers New Jersey Medical School

Benjamin Press

Medical Student
Rutgers - New Jersey Medical School
Newark, New Jersey

Radhika Ragam

Medical Student
Rutgers - New Jersey Medical School
Flemington, New Jersey

Helaine Koster

Hackensack University Medical Center
Hackensack, New Jersey

Tenzin Lama-Tamang

Hackensack University Medical Center
Hackensack, New Jersey

John Stites

Hackensack University Medical Center
Hackensack, New Jersey

Mutahar Ahmed

Attending Urologist
Hackensack University Medical Center
Maywood, New York

Mutahar Ahmed MD FACS
Director of the Center for Bladder Cancer and Reconstructive Urologic Surgery at Hackensack University Medical Center, in Hackensack, NJ
Clinical Assitant Professor Hackensack Meridian Seton Hall School of Medicine
Clinical Assistant Professor Rutgers University School of Medicine

Gregory Lovallo

Attending Urologist
Hackensack University Medical Center
Hackensack, New Jersey

Ravi Munver

Professor & Vice Chair
Hackensack University Medical Center
Hackensack, New Jersey

Michael D. Stifelman

Chairman - Department of Urology
Hackensack University Medical Center
Hackensack, New Jersey