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February 8, 2006

Critically Ill Patients and Acute Renal Failure

JAMA. 2006;295(6):624-625. doi:10.1001/jama.295.6.624-a

To the Editor: The multinational study of acute renal failure (ARF) in critically ill patients by Dr Uchino and colleagues1 supports findings of a number of smaller studies.24 However, we would like to raise some questions about the results. First, enrollment of patients younger than 18 years is unusual in adult trials, and this decision may have had an impact on cohort mortality. Second, general predictive scores (Acute Physiology and Chronic Health Evaluation [APACHE] II, Sequential Organ Failure Assessment [SOFA], Simplified Acute Physiology Score [SAPS] II) do not perform well when applied to patients with ARF.4 Applying a specific predictive score2,3 to such a variety of practices and diversity of populations might have been more valuable.