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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: Dr Mehta and colleagues1 failed to adjust for many of the significant differences between patients who did and did not receive diuretics. While the authors use a propensity score designed to adjust for some differences, they did not include acute cardiac failure and physiological indicators of advanced cardiac dysfunction (ie, lower cardiac output and cardiac index, higher pulmonary artery wedge pressure, and higher systemic vascular resistance in the diuretic group) into this model or the multivariate logistic regression; they include only the heart rate (not different between the groups) in the latter. The inclusion of the history of heart failure in the statistical models does not adjust for other or more acute cardiac factors that may have had a significant effect on both diuretic use and mortality.

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