RANDOMIZED CONTROLLED TRIAL OF THE EFFECT OF MANNITOL ON RENAL REPERFUSION INJURY DURING AORTIC-ANEURYSM SURGERY

The effects of mannitol on renal impairment following infrarenal aorti c aneurysm repair were studied. Patients received either mannitol 0.3 g/kg (n = 15) or saline (n = 13) as a rapid intravenous infusion befor e aortic cross-clamping. One patient in the control group developed fa tal postoperative renal failure but there was no renal failure in the mannitol group. Two patients treated with mannitol died from periopera tive myocardial infarction. There were no significant differences in p ostoperative blood urea level, serum creatinine concentration or creat inine clearance between mannitol and control groups. In patients who h ad mannitol there was a significant diuresis on the first day after op eration (mean urine output 2250 ml) compared with before operation (15 57 ml) (P = 0.007). Compared with controls, patients treated with mann itol had lower mean (s.e.m.) postoperative levels of urinary albumin ( 160(32) versus 500(140) mg per mmol creatinine; P = 0.036) and N-acety l glucosaminidase (143(34) versus 271(70) mu mol per mmol creatinine; P = 0.04) indicating a reduced level of subclinical glomerular and ren al tubular damage. These data demonstrate that mannitol reduces subcli nical renal injury following infrarenal aortic aneurysm repair.