Evidence map›Paper›PMID 41266849›Full record

SynthesisSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2025

Mannitol for prevention of cisplatin-induced nephrotoxicity: a systematic review and meta-analysis of randomized controlled trials.

Chih-Chin Kao, Hsiu-Yu Tai, Yueh-Chu Sio, Yen-Chung Lin, Tu T Tran, Tsai-Wei Huang

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Digital and AI-enhanced psychosocial interventions in breast cancer patients: a systematic review and meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Chih-Chin KaoDivision of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Hsiu-Yu TaiSchool of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Yueh-Chu SioDivision of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Yen-Chung LinDivision of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Tu T TranDepartment of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam.
Tsai-Wei HuangResearch Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. tsaiwei@tmu.edu.tw.ORCID http://orcid.org/0000-0002-6722-1153

Funding

Taipei Medical University and Wan Fang Hospital 112TMU-WFH-10
6 · The paper itself

Abstract

backgroundCisplatin causes nephrotoxicity in approximately 30% of patients. Mannitol has been proposed as a nephroprotective agent, yet the clinical evidence remains inconclusive.

methodsWe systematically searched PubMed, EMBASE, and the Cochrane Library through December 2024 for randomized controlled trials (RCTs) evaluating mannitol versus control interventions for prevention of cisplatin-induced nephrotoxicity. The primary outcome was acute kidney injury (AKI), standardized across CTCAE, AKIN, and RIFLE systems. Given heterogeneous comparators, analyses were stratified by control type without cross-comparator pooling. Odds ratios (ORs) were used for AKI; risk differences (RDs) were used for adverse events. Pooled estimates were generated only when ≥ 5 trials were available per stratum.

resultsNine RCTs (357 participants) were included. For severe AKI (grade ≥ 2), three small trials (n = 164) were available. Two placebo-controlled studies showed lower AKI risk with mannitol (absolute reductions ~ 15-20%), while one furosemide-controlled study showed no clear difference. These preliminary observations require confirmation in larger trials. For overall AKI (grade ≥ 1; six trials, n = 297), results were inconsistent across studies. Renal function outcomes were heterogeneous: one placebo-controlled trial favored mannitol, one hydration-controlled trial favored control, and a furosemide-controlled trial showed minimal difference. Adverse events were sparsely reported: no consistent differences were seen for electrolyte or hematological toxicities, while several studies suggested modest reductions in nausea/vomiting and a possible increase in diarrhea.

conclusionsBased on only three small trials (n = 164), preliminary trends suggest mannitol might reduce severe AKI in cisplatin-treated patients, particularly versus placebo. However, this evidence is insufficient to support clinical implementation. The observed protective trend should be considered hypothesis-generating rather than definitive. Effects on overall AKI, renal function, and toxicities remain inconclusive. Larger, well-designed RCTs with adequate statistical power are urgently needed before mannitol can be recommended for routine nephroprotection in clinical practice.

Indexed as

Acute Kidney InjuryAntineoplastic AgentsCisplatinMannitolHumansRandomized Controlled Trials as TopicAntineoplastic AgentsCisplatinMannitolAcute kidney injury (AKI)Chemotherapy toxicityCisplatin nephrotoxicityHydration protocolsMannitolMeta-analysisNephroprotection

Identifiers

PMID41266849

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.