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March 19, 2003

Diuretics in Critically Ill Patients With Acute Renal FailureDiuretics in Critically Ill Patients With Acute Renal Failure

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: I am concerned that the sample in the study by Dr Mehta and colleagues1 was biased, thus potentially confounding their results. Patients were included if they had ARF and received nephrology consultations. At the time of consultation, 59% of patients had already received diuretics. It seems likely that for most patients nephrology consultation was only pursued once diuretic therapy had been tried and was unsuccessful. For patients who had had a positive response to diuretic therapy, nephrology consultation would be deemed unnecessary and these patients would then be excluded from this study's sample, thus biasing the results toward an unfavorable outcome. The failure of response to diuretics and necessity of nephrology consultation would therefore be markers of severity of renal failure, not lack of utility of diuretics in all patients.

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