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March 19, 2003

Diuretics in Critically Ill Patients With Acute Renal Failure—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(11):1379-1381. doi:10.1001/jama.289.11.1379-a

To the Editor: Dr Mehta and colleagues1 reported that patients in the intensive care unit who received diuretics for acute renal failure (ARF) had a higher risk of dying and nonrecovery of renal function than those who did not.

I am concerned that the authors' use of the odds ratios may misrepresent the difference in risk of death between the 2 groups, which would be better expressed with risk ratios. Odds ratios are not analogous to risk ratios, particularly when the outcome in question occurs commonly. The authors state that "diuretic use was associated with a 68% (95% confidence interval [CI], 6%-164%) increase in in-hospital mortality and a 77% (95% CI, 14%-176%) increase in the odds of death or nonrecovery of renal function." This statement is misleading and suggests a much larger increased risk from diuretics than was actually observed. The risk of dying with or without diuretics is very high and the actual increase in risk of death associated with diuretics was more on the order of 20% to 25%.

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