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To the Editor: The multinational study of acute renal failure (ARF) in critically ill patients by Dr Uchino and colleagues¹ supports findings of a number of smaller studies.^2-4 However, we would like to raise some questions about the results. First, enrollment of patients younger than 18 years is unusual in adult trials, and this decision may have had an impact on cohort mortality. Second, general predictive scores (Acute Physiology and Chronic Health Evaluation [APACHE] II, Sequential Organ Failure Assessment [SOFA], Simplified Acute Physiology Score [SAPS] II) do not perform well when applied to patients with ARF.⁴ Applying a specific predictive score^2-3 to such a variety of practices and diversity of populations might have been more valuable.

Third, requiring renal replacement therapy (RRT) is definitely an indication of severity of illness in patients receiving intensive care for ARF, yet 27.5% of the cohort did not undergo dialysis. The mortality rate for . . . [Full Text of this Article]

Domingos O. d’Avila, MD, PhD
dominavila@pucrs.br

Carlos E. Poli de Figueiredo, MD, PhD
Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia)
IPB/HSL/Faculdade de Medicina–PUCRS
Porto Alegre, Brazil

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