Beyond eGFR: critical appraisal of mannitol use in nephron- sparing surgery
Abstract
This letter evaluates the randomized trial by Cheriyan et al. regarding mannitol administration in laparoscopic nephron-sparing surgery. Major unaddressed limitations consist of arbitrary margin equivalences, dependence on per-protocol rather than intention-to-treat analysis, exclusion of functional renal imaging, and insufficient control of surgical confounders like warm ischemia duration. Moreover, the exclusion of individuals with chronic kidney disease limits generalizability. Drawing on previous PubMed-indexed studies, we emphasize these methodological flaws and promote the need for more stringent designs to elucidate mannitol's protective effects on the kidneys in contemporary nephron-sparing surgery.
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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