Does intensive insulin therapy protect renal function in critically ill patients?

作者：Bellomo Rinaldo^*

来源：Nature Clinical Practice Nephrology, 2008, 4(8): 412-413.

DOI：10.1038/ncpneph0855

• critically ill patients
• intensive care unit
• intensive insulin therapy
• renoprotection
• RIFLE

This Practice point commentary discusses the findings of a paper by Schetz and colleagues, who presented a combined analysis of two studies on the renoprotective effect of intensive insulin therapy (IIT) that were conducted at their institution, one in patients in a surgical intensive care unit and the other in patients in a medical intensive care unit. The paper described a significant cumulative beneficial effect of IIT on the development of different levels of modified RIFLE (Risk, Injury, Failure, Loss, and End-stage renal disease) categories for acute kidney injury, on oliguria and on the need for renal replacement therapy. Although such data seem promising and provide a rationale for further investigation, confirmation from multicenter studies is required. More-recent multicenter investigations (the VISEP and Glucontrol trials) unfortunately showed no beneficial effects of IIT on renal function. Given such contradictory findings, clinicians should await the results of the large (n = 6,100) NICE-SUGAR trial, which is scheduled to randomize its last patient in August 2008.

• 出版日期2008-8