Michael Rodgers
(2012-11-08 13:38) University Medical Centre Groningen
Chawla et al make a case for "resting" the kidney. I find this a rather peculiar,
non-medical term to use. I presume what they mean is to reduce the metabolism of the
organ.
They claim that "rested" organs have resulted in improvement in outcome in patients
with ARDS and cardiogenic shock. However, in the landmark ARDSnet trial, the "rested"
group with the lower tidal volumes had in fact a higher minute ventilation compared
to the control group. The improvement in outcome in this trial was therefore not due
to more "rested" lungs.
In the recent IABP-SHOCK II trial there was no mortality improvement in patients with
cardiogenic shock after an acute myocardial infarction placed on an intra-aortic balloon
pump The "rested" group had the same mortality as the "un-rested" group.
Furthermore, no trial has ever shown furosemide to improve renal function in any cause
of renal failure, despite furosemide reducing oxygen consumption in the renal tubular
cells and thus "resting" the kidney.
The trial design the authors offer is interesting, but the likelihood that an outcome
difference would be because of a "rested" kidney is unlikely.
Viewpoint
Restful organs
Michael Rodgers (2012-11-08 13:38) University Medical Centre Groningen
Chawla et al make a case for "resting" the kidney. I find this a rather peculiar, non-medical term to use. I presume what they mean is to reduce the metabolism of the organ.
They claim that "rested" organs have resulted in improvement in outcome in patients with ARDS and cardiogenic shock. However, in the landmark ARDSnet trial, the "rested" group with the lower tidal volumes had in fact a higher minute ventilation compared to the control group. The improvement in outcome in this trial was therefore not due to more "rested" lungs.
In the recent IABP-SHOCK II trial there was no mortality improvement in patients with cardiogenic shock after an acute myocardial infarction placed on an intra-aortic balloon pump The "rested" group had the same mortality as the "un-rested" group.
Furthermore, no trial has ever shown furosemide to improve renal function in any cause of renal failure, despite furosemide reducing oxygen consumption in the renal tubular cells and thus "resting" the kidney.
The trial design the authors offer is interesting, but the likelihood that an outcome difference would be because of a "rested" kidney is unlikely.
Competing interests
No competing interest
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