뇌부종이 있는 뇌경색 환자들에서 만니톨로 인한 신부전증의 예측 인자

Abstract

Background Renal failure is known as one of the mannitol’s most common side effects. It is very little known about cause, incidence, risk factors, and outcome of mannitol induced renal failure. The goal of this study is to determine predicting factors of mannitol induced renal failure.

Methods We retrospectively reviewed the medical records of all ischemic stroke patients treated with mannitol due to brain edema from January 2008 to December 2010in Chosun university hospital. From among 125 patients, 25 patients received mannitol below 3 days were excluded and 100 patients were selected. A15% or 25% mannitol was administered intravenously by intermittent bolus and maximum dose was below 200g/day. Renal failure was defined as an increase in the creatine level of > 0.5 mg/dl if the base-line value is < 2 mg/dl or an increase > 1 mg/dl if the base-line value is > 2 mg/dl.

Results The 14 patients(14%) were diagnosed as mannitol induced renal failure. Glucose level before use of mannitol and peak osmolarity during mannitol treatment were associated with renal failure in univariate analysis. In logistic regression analysis with suspected factors (P<0.1), independent predictive factors of mannitol induced renal failure were glucose level before use of mannitol, (1.014, 1.000-1.027,p=0.043) and peak osmolality (OR 1.041 95% CI 1.009-1.075, p=0.01).

Conclusion Strict glucose control before mannitol treatment may be able to reduce the rate of renal failure occurrence. However, the recovery rate from renal failure was not confirmed in our study because of short follow up period.