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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-b

To the Editor: Dr Uchino and colleagues1 identified risk factors associated with hospital mortality in critically ill patients with ARF, including mechanical ventilation and use of vasopressors. However, they did not describe whether diabetes mellitus was related to morbidity and mortality of ARF.

Schmekal et al2 found that in patients with nontraumatic ARF requiring dialysis, congestive heart failure and hypovolemia occurred more frequently in patients with diabetes compared with those without diabetes (P<.05). This suggests that diabetes mellitus could be one of the important risk factors triggering ARF. Although Schmekal et al also reported that the overall mortality was not significantly different between patients with and without diabetes,2 the relationship between diabetes and mortality in critically ill patients with ARF remains unclear. It would be helpful if the authors could provide information related to this potential risk factor.