title: Impact of glycemic control on the incidence of acute kidney injury in critically ill patients: a comparison of two strategies using the RIFLE criteria.
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.
  
  
  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.
authors.affiliation: Intensive Care Units of São Domingos Hospital, Dr Clementino Moura Hospital, São Luis, MA, Brazil. jrazevedo@elo.com.br
authors.forename: José Raimundo Araújo de
authors.initials: JR
authors.lastname: Azevedo
authors.forename: Renato Palácio de
authors.initials: RP
authors.lastname: Azevedo
authors.forename: Lara Carneiro de
authors.initials: LC
authors.lastname: Lucena
authors.forename: Nathalia de Nazaré Rabelo da
authors.initials: Nde N
authors.lastname: Costa
authors.forename: Widlane Sousa da
authors.initials: WS
authors.lastname: Silva
mesh_terms: 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
chemical_list: D001786:Blood Glucose