Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
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.
James V. Tedesco. Diuretics in Critically Ill Patients With Acute Renal FailureDiuretics in Critically Ill Patients With Acute Renal Failure. JAMA. 2003;289(11):1379–1381. doi:10.1001/jama.289.11.1379-a