Abstract
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Schetz M et al. (2008) Tight blood glucose control is renoprotective in critically ill patients. J Am Soc Nephrol 19: 571–578
Bellomo R et al. (2004) 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 8: R204–R212
Van den Berghe G et al. (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345: 1359–1367
Van den Berghe G et al. (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354: 449–461
Egi M et al. (2006) Intensive insulin therapy in postoperative ICU patients: a decision analysis. Am J Respir Crit Care Med 173: 407–413
Brunkhorst FM et al. (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358: 125–139
Preiser J-C (2007) Intensive glycemic control in med-surg patients (European Glucontrol trial). Presented at the Society of Critical Care Medicine 36th Critical Care Congress: 2007 February 17–21, Orlando, FL, USA
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author declares no competing financial interests.
Rights and permissions
About this article
Cite this article
Bellomo, R. Does intensive insulin therapy protect renal function in critically ill patients?. Nat Rev Nephrol 4, 412–413 (2008). https://doi.org/10.1038/ncpneph0855
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0855
This article is cited by
-
Section 3: Prevention and Treatment of AKI
Kidney International Supplements (2012)
-
References
Kidney International Supplements (2012)