Intensive insulin therapy cuts kidney injury risk for critically ill patients

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Washington, January 31 : A new study has revealed that intensive insulin therapy (IIT), which keeps blood sugar at normal levels, also reduces the risk of acute kidney injury for critically ill patients.

Published in the Journal of the American Society of Nephrology, the study builds on previous randomised trials, including more than 2,700 patients, which reached the "startling" conclusion that IIT reduces the risk of death in critically ill patients.

Lead author Dr. Miet Schetz, an expert at the University of Leuven, Belgium, has revealed that in each of the study, one group of patients received IIT, with insulin given continuously to maintain normal glucose levels. The other group received conventional insulin therapy, in which blood glucose levels are allowed to rise above normal, Schetz says.

The researchers reanalysed the trial data by focusing on differences in the rates of acute kidney injury (AKI) between the two treatment groups. They observed that

Acute kidney injury is a common and serious complication among patients admitted to the intensive care unit (ICU). It occurs in five to 30 percent of patients, with death rates exceeding 40 percent.

The researchers observed that AKI developed in 4.5 percent of patients assigned to IIT, compared to 7.6 percent of those receiving conventional insulin therapy. The reduction in AKI was greatest when glucose levels remained within the normal range.

According to them, IIT was more effective in protecting against AKI in patients admitted to the ICU after surgery (surgical ICU), compared to critically ill patients who did not undergo surgery (medical ICU).

"This difference can be explained by the fact that IIT is a preventive strategy that cannot heal damage that is already present. The medical ICU patients were much sicker to begin with and may have already had kidney damage," said Dr. Schetz.

"This finding is especially important, because intensive insulin therapy is the first medical treatment that has been clearly shown to protect the kidney of critically ill patients," Dr. Schetz adds.

The researcher, however, agreed that more research was needed to clarify how IIT acts to protect the kidneys-whether by preventing direct kidney damage caused by high blood sugar, or through indirect effects.

Regardless of the mechanism, Dr. Schetz concludes, "Since AKI is associated with increased morbidity and mortality, the goal should be to prevent its development."

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