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Insulin Therapy Protects Kidneys of Surgical Patients

Medical intensive care unit patients show some benefits, too

WEDNESDAY, Feb. 6 (HealthDay News) -- Intensive insulin therapy given to critically ill patients in surgical and medical intensive care units was shown to protect the patients' renal function better than standard insulin therapy, according to a report published in the February issue of the Journal of the American Society of Nephrology.

Miet Schetz, M.D., Ph.D., and colleagues from the Catholic University of Leuven in Belgium, analyzed data from two randomized, controlled trials encompassing 2,707 patients: 1,540 in surgical intensive care units (ICUs) and 1,167 in medical ICUs. The patients were randomized to one of two arms of the study: receiving conventional insulin treatment that kept blood glucose levels between 180-200 mg/dL, or intensive insulin therapy, which brought blood glucose levels down to 80-110 mg/dL.

Intensive insulin therapy reduced the incidence of renal injury and renal failure in all patients (from 4.6 to 3 percent and 3.1 to 1.5 percent respectively), but the greater effect appeared to be in the patients in surgical ICUs, in whom oliguria was decreased from 5.6 to 2.6 percent, the need for renal replacement therapy was decreased from 7.4 to 4 percent, and the combined endpoint for acute kidney injury was decreased from 13.7 to 10 percent. Limitations of the study include that kidney injury was a secondary outcome measure, there was no correction for multiple comparisons and some subgroups had limited sample sizes.

Schetz and colleagues conclude that "this secondary analysis of two large randomized, controlled trials showed that intensive insulin therapy targeting normoglycemia protects the kidney of critically ill patients."

One of the authors disclosed a financial relationship with Novo Nordisk.

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