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


BACKGROUND
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.


CONCLUSIONS
Intensive insulin therapy and a carbohydrate-restrictive strategy were comparable regarding the incidence of acute kidney injury evaluated using RIFLE criteria.
Azevedo
José Raimundo Araújo de
JR
Intensive Care Units of São Domingos Hospital, Dr Clementino Moura Hospital, São Luis, MA, Brazil. jrazevedo@elo.com.br
Azevedo
Renato Palácio de
RP
Lucena
Lara Carneiro de
LC
Costa
Nathalia de Nazaré Rabelo da
Nde N
Silva
Widlane Sousa da
WS
D018806:APACHE; D058186:Acute Kidney Injury / Q000145:classification / Q000401:mortality / Q000628:therapy*; D001786:Blood Glucose / Q000032:analysis*; D001938:Brazil / Q000453:epidemiology; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
D001786:Blood Glucose