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To the Editor: Dr Mehta and colleagues¹ concluded that the use of diuretics in critically ill patients with ARF is associated with a poor outcome. Even though the authors indicate that observational data prohibit causal inference, they argue that in the absence of compelling contradictory data from clinical trials, the widespread use of diuretics in critically ill patients with ARF should be discouraged. This conclusion, however, may be flawed since the methods used by the authors do not regard the epidemiological theory of causality.

The choice of diuretic use in a critically ill patient is almost invariably a consequence, and not a cause, of the degree of the severity of the clinical picture, such as existence or lack of oligoanuria or electrolyte disarrays. The decision to administer diuretics is guided by the clinical status of the patient and is based on the assessment of a physician who usually has sound . . . [Full Text of this Article]

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