Key result
Intensive insulin therapy and a carbohydrate-restrictive strategy resulted in comparable renal function outcomes (p=0.37) and incidence of acute kidney injury (51.8% vs 52.5%, p=0.91) in critically ill patients.
Why the study?
Does intensive insulin therapy compared to a carbohydrate-restrictive strategy improve renal function outcomes in critically ill patients?
RCT (n=228)
Randomized to one of two glycemic control strategies
Yes
Does intensive insulin therapy compared to a carbohydrate-restrictive strategy improve renal function outcomes in critically ill patients?
Answers are grounded in this paper and cite their sources.
A carbohydrate-restrictive strategy is as effective as intensive insulin therapy in preventing acute kidney injury in critically ill patients, but with a significantly lower risk of hypoglycemia.
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.
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Örnek et al. (2010) conducted an RCT in Critical illness with hyperglycemia (n=228). Intensive insulin therapy vs. Carbohydrate-restrictive strategy (glucose-free hydration, low-carbohydrate enteral nutrition, and subcutaneous insulin) was evaluated on Renal function outcome (classified as unfavorable, stable, or favorable based on RIFLE criteria changes) (p=0.37). Intensive insulin therapy and a carbohydrate-restrictive strategy resulted in comparable renal function outcomes (p=0.37) and incidence of acute kidney injury (51.8% vs 52.5%, p=0.91) in critically ill patients.
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