Impact of Glycemic Control on the Incidence of Acute Kidney Injury in Critically Ill Patients: a Comparison of Two Strategies Using the RIFLE Criteria

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2010 Sep 14

PMID 20835553

Citations 6

Authors

Jose Raimundo Araujo de Azevedo

Renato Palacio de Azevedo

Lara Carneiro de Lucena

Nathalia de Nazare Rabelo da Costa

Widlane Sousa da Silva

Affiliations

Soon will be listed here.

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.

Citing Articles

Investigation of AKI with Early Biomarkers After Cardiac Surgery.

Mutlu H, Gunduz E, Titiz T, Ozen Kucukcetin I Braz J Cardiovasc Surg. 2020; 35(5):722-731.

PMID: 33118738 PMC: 7598966. DOI: 10.21470/1678-9741-2019-0178.

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients.

Kocogullari C, Kunt A, Aksoy R, Duzyol C, Parlar H, Saskin H Braz J Cardiovasc Surg. 2017; 32(2):83-89.

PMID: 28492788 PMC: 5409247. DOI: 10.21470/1678-9741-2016-0010.

Bridging translation for acute kidney injury with better preclinical modeling of human disease.

Skrypnyk N, Siskind L, Faubel S, de Caestecker M Am J Physiol Renal Physiol. 2016; 310(10):F972-84.

PMID: 26962107 PMC: 4889323. DOI: 10.1152/ajprenal.00552.2015.

Hyperglycemia and Acute Kidney Injury During the Perioperative Period.

Mendez C, Der Mesropian P, Mathew R, Slawski B Curr Diab Rep. 2016; 16(1):10.

PMID: 26792142 DOI: 10.1007/s11892-015-0701-7.

Acute Kidney Injury Subsequent to Cardiac Surgery.

Kramer R, Herron C, Groom R, Brown J J Extra Corpor Technol. 2015; 47(1):16-28.

PMID: 26390675 PMC: 4566816.

References

Bagshaw S, George C, Bellomo R . Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care. 2008; 12(2):R47. PMC: 2447598. DOI: 10.1186/cc6863. View

Antonio Lopes J, Fernandes P, Jorge S, Goncalves S, Alvarez A, Silva Z . Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care. 2008; 12(4):R110. PMC: 2575599. DOI: 10.1186/cc6997. View

Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters P, Milants I . Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354(5):449-61. DOI: 10.1056/NEJMoa052521. View

Bagshaw S, George C, Bellomo R . A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008; 23(5):1569-74. DOI: 10.1093/ndt/gfn009. View

Mehta R, Kellum J, Shah S, Molitoris B, Ronco C, Warnock D . Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007; 11(2):R31. PMC: 2206446. DOI: 10.1186/cc5713. View

Ostermann M, Chang R . Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007; 35(8):1837-43. DOI: 10.1097/01.CCM.0000277041.13090.0A. View

Hoste E, Clermont G, Kersten A, Venkataraman R, Angus D, De Bacquer D . RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006; 10(3):R73. PMC: 1550961. DOI: 10.1186/cc4915. View

Finfer S, Chittock D, Su S, Blair D, Foster D, Dhingra V . Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009; 360(13):1283-97. DOI: 10.1056/NEJMoa0810625. View

Nobrega A, Gomes C, Lemos C, Bregman R . Is it possible to use modification of diet in renal disease (MDRD) equation in a Brazilian population?. J Nephrol. 2006; 19(2):196-9. View

10.

Hoste E, Kellum J . Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care. 2006; 12(6):531-7. DOI: 10.1097/MCC.0b013e3280102af7. View

11.

Wiener R, Wiener D, Larson R . Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008; 300(8):933-44. DOI: 10.1001/jama.300.8.933. View

12.

Brunkhorst F, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N . Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008; 358(2):125-39. DOI: 10.1056/NEJMoa070716. View

13.

de Azevedo J, de Araujo L, da Silva W, Azevedo R . A carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients. J Crit Care. 2009; 25(1):84-9. DOI: 10.1016/j.jcrc.2008.10.011. View

14.

Levey A, Bosch J, Lewis J, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6):461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. View

15.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

16.

Lecomte P, Van Vlem B, Coddens J, Cammu G, Nollet G, Nobels F . Tight perioperative glucose control is associated with a reduction in renal impairment and renal failure in non-diabetic cardiac surgical patients. Crit Care. 2008; 12(6):R154. PMC: 2646319. DOI: 10.1186/cc7145. View

17.

Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C . An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006; 34(7):1913-7. DOI: 10.1097/01.CCM.0000224227.70642.4F. View

18.

Bellomo R, Ronco C, Kellum J, Mehta R, Palevsky P . Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8(4):R204-12. PMC: 522841. DOI: 10.1186/cc2872. View