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<p>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.</p>

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Beyond eGFR: critical appraisal of mannitol use in nephron- sparing surgery

  • 期刊论文

  • 发表日期：

    2025年8月21日

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  • Huda Faisal,
  • Siffat Ullah,
  • Hussain Ramzan

摘要

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.