Thomas G et al. (2007) Insulin therapy and acute kidney injury in critically ill patients—a systematic review. Nephrol Dial Transplant [doi:10.1093/ndt/gfm401]

A recent systematic review and meta-analysis has investigated whether intensive insulin therapy reduces the incidence of acute kidney injury (AKI) in hyperglycemic critically ill adults.

Five studies were included in the analysis, three of which were randomized controlled trials that compared conventional insulin therapy (target glucose 10–11 mmol/l [180–200 mg/dl]) with intensive insulin therapy (target glucose 4.4–5.6 mmol/l [80–100 mg/dl]) in hospitalized, hyperglycemic critically ill adults. These studies evaluated AKI (defined as a twofold increase in serum creatinine or a serum creatinine increase to at least 221 µmol/l [2.5 mg/dl]) as a secondary outcome. The other two studies included in the analysis were prospective cohort studies.

The primary analysis involved the 2,864 analyzable patients in the three randomized controlled studies. Among these patients, the risk of AKI was significantly lower with intensive insulin therapy than with conventional insulin therapy (relative risk [RR] 0.62, 95% confidence interval 0.41–0.96; P = 0.03). Intensive insulin therapy also reduced the risk of AKI by 38% in an expanded analysis that included 5,165 analyzable patients across all five studies (RR 0.62, 95% CI 0.47–0.83; P = 0.001). Among these 5,165 patients, the risk of hypoglycemia was significantly higher in patients treated with intensive insulin therapy than in those treated with conventional insulin therapy (RR 4.5, 95% CI 2.4–8.5; P <0.00001). According to the researchers, the clinical risk of severe hypoglycemia might outweigh the clinical benefit of intensive insulin therapy, but further research is needed.