CLINICS

Clinics (Sao Paulo). 2010 August; 65(8): 769-773.
doi:10.1590/S1807-59322010000800006

Copyright © 2010 Hospital das Clínicas da FMUSP

Impact of glycemic control on the incidence of acute kidney injury in critically ill patients: a comparison of two strategies using the RIFLE criteria

José Raimundo Araújo de Azevedo , Renato Palácio de Azevedo , Lara Carneiro de Lucena , Nathalia de Nazaré Rabelo da Costa , Widlane Sousa da Silva

Intensive Care Units of São Domingos Hospital and Dr. Clementino Moura Hospital - São Luis/MA,Brazil

E-mail: jrazevedo@elo.com.br Tel.: 55 98 3227 5735

received February 5, 2010; revised March 29, 2010; accepted May 10, 2010.

Abstract

OBJECTIVE:

To compare the renal outcome in patients submitted to two different regimens of glycemic control, using the RIFLE criteria to define acute kidney injury.

INTRODUCTION:

The impact of intensive insulin therapy on renal function outcome is controversial. The lack of a criterion for AKI definition may play a role on that.

METHODS:

Included as the subjects were 228 randomly selected, critically ill patients engaged in intensive insulin therapy or in a carbohydrate-restrictive strategy. Renal outcome was evaluated through the comparison of the last RIFLE score obtained during the ICU stay and the RIFLE score at admission; the outcome was classified as favorable, stable or unfavorable.

RESULTS:

The two groups were comparable regarding demographic data. AKI developed in 52% of the patients and was associated with a higher mortality (39.4%) compared with those who did not have AKI (8.2%) (p<0.001). Renal function outcome was comparable between the two groups (p = 0.37). We observed a significant correlation between blood glucose levels and the incidence of acute kidney injury (p = 0.007). In the multivariate logistic regression analysis, only APACHE III scores higher than 60 were identified as an independent risk factor for unfavorable renal outcome. APACHE III scores>60, acute kidney injury and hypoglycemia were risk factors for mortality.

CONCLUSION:

Intensive insulin therapy and a carbohydrate-restrictive strategy were comparable regarding the incidence of acute kidney injury evaluated using RIFLE criteria.

Keywords: Critical illness, Insulin, Hypoglycemia, Renal failure, Glycemic control


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