Mannitol Infusion in Regular Haemodialysis Treatment for Chronic Renal Insufficiency

Abstract

A therapeutic double blind trial with intravenous mannitol infusion to six patients in a chronic haemodialysis programme is described. During three-week periods infusions were given at each dialysis as follows: series I: 1 g mannitol/kg body weight, II: 0.5 g mannitol/kg body weight, III and IV: placebo. In the series I—III the glucose content of the dialysate was 0.9 g% and in series IV 1.8 g%. The patients reported on a questionnaire complaints which arose during and between the dialysis, while the nurses, on a similar form, recorded the complaints which appeared during the treatments. In addition to the conventional laboratory tests plasma mannitol, plasma osmolality and blood sugar were determined. The plasma mannitol concentration fell to approximately half between the dialyses when the mean dialysis-free interval was 3.2 days. Progressive accumulation of mannitol in the patients was not obtained under these conditions. The fall in osmolality during dialysis when using 0.9 g% glucose in the dialysate was significantly lower in the mannitol series than in the placebo series. Among reported complaints only muscle cramps varied significantly between the series, and the occurrence of the cramps was lowest during the mannitol periods. No therapeutic advantages could be shown in using 1.8 g% glucose in the dialysate instead of 0.9 g%. The results indicate that intravenous mannitol infusion of 0.5–1 g/kg body weight during dialysis can be of value in reducing the occurrence of muscle cramps in chronic kidney patients undergoing regular dialysis treatment.