Search Strategy
MEDLINE (1966 through 2009, April), EMBASE (1980 through 2009, Week 15), CINAHL (1982 through 2009, April), Web of Science (1955 through2009)
and PubMed /Pub Med CENTRAL were used to identify key studies, preferably randomized placebo-controlled trials (RCT) and meta-analyses, addressing
the use of therapeutic strategies to prevent AKI/ARF in adult critically ill patients. The following clinical conditions were considered: major
surgery, critical illness, sepsis, shock, use of potentially nephrotoxic drugs and radiocontrast. Transplantation, primary renal disease (e.g.
vasculitis) and the hepatorenal syndrome were not considered.
The following terms and text words were used:
‘kidney failure, acute’, ‘kidney failure, acute/prevention and control’, ‘renal’,
‘cardiac surgery’, ‘sepsis’, ‘contrast’, ‘shock’
‘fluid……..
‘diuretics…….
‘noradrenalin’…….
‘dopamine’, ‘dobutamine’, ‘dopexamine’, ‘fenoldopam’, ‘clonidine’
‘atrial natriuretic factor’, ‘aminophylline’. ‘pentoxifylline’, ‘enoximone’,
‘prostaglandins’, ‘ACE inhibitors’, ‘calcium antagonists’
‘insulin’…..
‘glutamin’….
‘activated protein C’
‘steroid‘, ‘hydrocortisone‘, ‘dexamethasone’
‘selenium’
‘vitamin C, ascorbic acid’
‘Vitamin E, ά-tocopherol’
The following endpoints were extracted:
Physiological endpoints:
 Creatinine clearance (CrCl), glomerular filtration rate (GFR), increase in serum creatinine (SeCr)
 Urine output (UO)
 Urinary biomarkers were not used, because their use as a marker of renal damage is at present not validated for clinical use on a large scale.
Clinical endpoints:
 ICU/hospital mortality
 Need for renal replacement therapy (RRT)
 Duration of RRT
GRADE
Studies are graded according to the system formulated by the international GRADE group. The grading scheme classifies recommendations as
strong (grade 1) or weak (grade 2), according to the balance among benefits, risks, burdens, and possibly cost, and the degree of confidence in
estimates of benefits, risks, and burdens. The system classifies quality of evidence as high (grade A), moderate (grade B), or low (grade C)
according to factors that include study design, consistency of the results, and the directness of the evidence.
TABLES
Table S1: Large RCT´s investigating colloids in critically ill patients.
Author
Year
Clinical setting
Intervention
Nr
trials or
patients
Endpoints
Results
Renal
protection
Clinical improvement
Finfer S
2004 [1]
Study
Design
Level
(A=C)
RCT
A
ICU patients
requiring fluid
resuscitation
 4% HA
 NS
3497
3500
28 day mortality
Duration RRT
20.9% vs 21.1%, p=0.87
0.5+2.3 vs. 0.4+2.0, p=0.41
no
no
Schortgen F
2001 [2]
RCT
B
Severe sepsis,
septic shock
 6% HES 200/0.6
 3% gelatine
65
65
42% vs 23%, p=0.028
OR 2.57 (CI 1.13-5.83)
yes (gelatine)
no
Brunkhorst
FM 2008 [3]
RCT
A
Severe Sepsis
 10% HES
200/0.5
 modified RL
262
275
56% vs. 37%, p=0.025
26.7% vs. 24.1%, p=0.48
34.9% vs. 22.8%, p=0.002
no
no
Stockwell
MA 1992 [4]
RCT
A
ICU patients
 4.5% HA

3.5% gelatine
226
249
ARF (twofold
increase in s-crea
or RRT)
Oliguria
28 day mortality
ARF (twofold
increase in s-crea
or RRT)
RRT
ARF
31.0% vs. 18.8%, p=0.001
1.3% vs. 2.0%, NS
no
no
RCT randomized controlled trial, HA Human serum albumin, ARF acute renal failure, RRT renal replacement therapy, RL ringer´s lactate
Table S2: Meta-analyses and one RCT not included in meta-analysis evaluating the effect of sodium-bicarbonate hydration (NaBic) on
contrast induced nephropathy (CIN)
Author
year
Hogan SE
2008
[5]
Joannidis M
2008 [6]
Navaneethan
SD 2009 [7]
Kanbay M
2009 [8]
Pakfetrat M
2009
[9]
Study
Design
Level
(A=C)
Metaanalysis
B
Metaanalysis
B
Metaanalysis
B
Metaanalysis
B
Clinical setting
Intervention
Nr
trials or
patients
Endpoints
Results
Renal
protection
Clinical improvement
Prevention CIN
 NaBic
 NS
7
1307
Development
CIN
OR 0.37 (CI 0.18-0.714)
yes
no
Prevention CIN
 NaBic
 NS
9
2043
Development
CIN
OR 0.45 (CI 0.26-0.79)
yes
no
Prevention CIN
 NaBic
 NS
12
1854
Development
CIN
OR 0.46 (CI 0.26-0.82)
yes
no
Prevention CIN
 NaBic
 NS
17
2448
Development
CIN
OR 0.54 (CI 0.36-0.83)
yes
no
RCT
B
Prevention CIN
 NaBic
 NS
 NS+
acetazolamid
96
96
94
Development of
CIN (RIFLE
Risk!)



yes
no
4,2%, p= 0.03
16.6%
5.3%, p=0.04
Table S3: Recent Meta-analyses and one RCT not included in meta-analysis evaluating the effect of loop diuretics on AKI
Author
year
Study
Design
Level
(A=C)
Metaanalysis
A
Clinical setting
Intervention
Nr
trials or
patients
Endpoints
Results
Renal
protection
Clinical
improvement
Adult imminent
/established ARF
 loop diuretics for
prevention/treatm
ent
9
849
Hospital mortality
RRT
Nr. dialysis sessions
persistence oliguria
RR 1.11 (CI 0.92-1.33)
RR 0.99 (CI 0.80-1.22)
-0.48 (CI -1.45-0.5)
0.54 (CI 0.18-1.61)
no
no
Bagshaw SM
2006 [11]
Metaanalysis
A
Adult established
ARF
 loop diuretics
5
555
Yes (UO)
Metaanalysis
A
ARF prophylaxis,
CRF

13
2520
OR 1.28 (CI 0.89-1.84)
OR 0.88 (CI 0.59-1.31)
- 1.4 d (CI -0.2- -2.3d)
OR 2.6 (CI 1.4-4.9)
RR 1.10 (CI 0.85-1.42)
-1.54d (CI -5.62 - 2.46d)
IRR 0.71 (CI 0.47-1.06)7.7d (CI -12.5- -2)
no
Sampath S
2007 [12]
Mortality
Renal recovery
Duration on RRT
Increase in UO
Mortality
Time to normalize creatinine
Dialysis Rate
Time to Diuresis >1500ml
no
no
Van der
Voort PHJ
2009 [13]
RCT
B
Established AKI
with RRT in ICU
 furosemide
 placebo
Hospital Mortality
Duration of RRT
Renal recovery
Urinary Output
36% vs. 32%, p=0.8
8.2d vs. 7.0d, p=0.74
72% vs. 77%, p=0.43
247 ml/h vs. 117 ml/h
p=0.003
no
Yes (UO)
Ho KM
2006 [10]
loop diuretics
36
35
UO urinary output, RRT renal replacement therapy, IRR incidence risk ratio
Table S4. Meta-analyses and RCT's not included in the meta-analyses evaluating the renal protective effect of fenoldopam
Author
year
Study
Design
Level
(A=C)
Clinical setting
Intervention
Nr
trials or
patients
Endpoints
Results
Renal
protection
Clinical
improve
ment
Landoni G
2007 [14]
Metaanalysis
B
Metaanalysis
A
Critically ill and
Cardiovascular
surgery
Cardiovascular
surgery
 fenoldopam
 placebo/control
16
1290
yes
13
1059
OR 0.44 (CI0.32-0.59)
OR 0.54 (0.34-0.84)
OR 0.64 (0.45-0.91)
OR 0.37 (0.23-0.59)
0.46 (0.29-0.75)
yes
 fenoldopam
 placebo/control
risk for AKI
need for RRT
Hosp. mortality
need for RRT
Hosp. mortality
yes
yes
Barr L
2008 [16]
RCT
C
Cardiac surgery
CrCl ≤ 40 ml/min

79
CrCl
-1.47 ml/min, p=0.03
-0.67 ml/min, p=0.02
-3.08 ml/min, p=0.09
-8.15 ml/min
some
no
Allaqaband
2002 [17]
RCT
C
ia contrast
CrCl < 60 ml/min
SeCr > 1.6 ml/dl
45
> 0.5 mg/dl after
48h

some
no
no
no
no
no
Landoni G
2008 [15]
Tumlin JA
2002 [18]
Stone GW
2003 [19]
Briguori
2004 [20]
RCT
C
RCT
B
RCT
B
ia contrast
angiography
ia contrast
CrCl < 60 ml/min
ia contrast
chronic renal
F
0.1μg/kg/min
 NAC 2x600
mg
 F + NAC
 control
 H + fenoldopam
0.1 g/kg/min
 H + NAC
 H 0.45 % saline
 H+ fenoldopam
0.1 g/kg/min
 H 0.45% saline
40
38
23
22
 fenoldopam
0.05-0.1 /kg/min
 placebo
157
 fenoldopam 0.1
g/kg/min
95
158
RPF
SCr > 0.5
mg/dl at 72h
Peak SeCr 72h
 SCr > 25% in
96h
 mortality
 RRT
SCr > 0.5
mg/dl at 48h
15.7 %

17.7 %
 15.3 % p=0.92
+16 vs -33% p<0.005
21 vs 41% p = 0.15
2.8 vs 3.6 mg/dl p<0.05
 33.6% vs 30.1%
 2% vs 1.9%
 2.6% vs 1.9%
13.7% vs 4.1%
OR 0.27 (0.08-0.85)
insufficiency
 NAC
97
AKI acute kidney injury, RRT renal replacement therapy, RCT randomized controlled trial, CrCl creatinine clearance, SCr serum creatinine, F
fenoldopam, NAC N-acetylcysteine, H hydration, ia intra-arterial, RPF renal plasma flow
Table S5: Randomized controlled studies evaluating the renal protective effect of clonidine
Author
year
Kulka PJ
1996 [21]
Study
Design
Level
(A=C)
RCT
C
Myles PS
1999 [22]
RCT
B
Clinical setting
Intervention
Nr
trials or
patients
Endpoints
Results
Renal
protection
Clinical
improve
ment
Cardiac surgery
normal risk
normal renal
function
Cardiac surgery
 clonidine (C)
4 μg/kg 1 h before
anaesthesia
 placebo (P)
 clonidine (C)
5 μg/kg twice
preoperatively
 placebo
23
CrCl d 1
some
no
25
156
CrCl d 3
CrCl
C: no change
P: d1: 98 (SD18)  68
(SD19) mL/min (p <05)
d3: no change
higher in C patients
yes
no
Quality of life
Partially better
RCT randomized controlled trial. CrCl creatinine clearance, d day
Table S6. Randomized controlled studies evaluating the renal protective effects of natriuretic peptides
Author
year
Study
Design
Evidence
(A-C)
Rahman SN
1994 [23]
RCT
nonblinded
C
Allgren RL
1997 [24]
RCT
B
Clinical setting
ARF
ARF
ARF
Meyer M
1999 [25]
RCT
B
Oliguric ARF
Lewis J
2000 [26]
RCT
B
Oliguric ARF
Bergman A
1996 [27]
RCT
C
Major surgery
Cardiac surgery
Normal renal
function
Wiebe K
1996 [28]
RCT
C
Oliguric ARF
post cardiac
Intervention
Nr
trials
patients
Endpoints
Results
Renal
protection
Clinical
Improve
ment
 h-ANP 0.20 or
0.08g/kg/min
24h
 control
20+10
Need for RRT
CrCl
yes
yes
23
mortality
23 vs 52%, p < 0.05
ANP: 9.9  21 ml/min,
p < 0.05, C: no change
17 vs 35%, p = 0.11
 h-ANP 0.2
g/kg/min for 24h
 placebo
248
21 d RRT free
survival
43 vs 47% (p = 0.35)
in oliguric patients
27 vs. 8 % (p = 0.008)
in non-oliguric patients
48 vs 59% (p = 0.03)
29 vs 26% (p=0.41)
yes
Only in
oliguric
subgroup
no
no
no
no
yes
no
yes
yes
256
 urodilatin 0.05,
0.20, 0.40 & 0.80
g/kg/min for 5d
 placebo
 h-ANP 0.20
g/kg/min for 24h
 placebo
176
 ANP 7.5
pMol/kg/min 3 h
postoperatovely
 placebo
 h-ANP 0.20
g/kg/min for 7d
all cause
mortality
hypotension
RRT-free during
the first 12 h
diuresis
46 vs 18% (p<0.001)
35%, 36%, 28%, 41%
vs. 36%
not different
108
21 d RRT-free
21% vs 15% (p = 0.22)
114
Psyst<90 mmHg
95 vs 55% (p < 0.001)
30
OU
GFR
increased in ANP
patients compared to
placebo (p < 0.001)
7
need of RRT
within 7 d
0 vs 6 (p < 0.005)
Herbert MK
1999 [29]
Swärd K
2004 [30]
RCT
C
RCT
C
Mentzer RM
2007 [31]
RCT
B
SacknerBernstein JD
2005 [32]r
Metaanalysis
B
Kurnik BR
1998 [33]
RCT
B
surgery
 placebo
7
ARF after major
abdominal
surgery
Post cardiac
surgery heart
failure if SeCr
>50%, preop
SeCr < 150
μmol/l
CABG with CPB
and EF  40%
 urodilatin 0.20
g/kg/min ≥ 96h
 placebo
 h-ANP 0.050
g/kg/min
longterm
 placebo
12
after > 7 d
mortality
Peak SCr
29
RRT free
RRT < 21 d
 neseritide
 placebo
135
137
decompensated heart failure
decompensated
 neseritide
heart failure
 control
contrast
ia (> 90%) or iv
contrast
LO-CM in 52%
SeCr >1.8
mg/dl
CrCl < 65
ml/min
 h-ANP 0.01
 h-ANP 0.05
 h-ANP 0.1
g/kg/min 30’
before to 30’ after
 placebo
H 0.45% saline
30
2 vs 6
0 vs 57%
4.6 vs 5.8 mg/dl
p = 0.15
not different
21 vs 47%
HR 0.28, CI 0.10-0.73
RRT or death <
21 d
CrCl
ΔSCr,ΔGFR,UO
100-d mortality
28 vs 57%
HR 0.35, CI 0.14-0.82
ANP: improved, pl: not
significantly better
6.6% vs. 14.7%
(p=0.046)
3
862
30-d mortality
7.2%
4.0%, p = 0.059
59
66
60
SCr > 0.5
mg/dl or > 25%
no
no
yes
yes
yes
yes
n.a.
no:worse
outcome
23 vs 23 vs 25 vs
19%
(not significant)
no
57
ARF acute renal failure, RCT randomized controlled trial, ANP atrial natriuretic factor, RRT renal replacement therapy, CrCl creatinine
clearance, SCre serum creatinine, RR relative risk, CrCl creatinine clearance, GFR glomerular filtration rate, UO urinary output, CABG
coronary artery bypass grafting, CPB cardiopulmonary bypass, EF ejection fraction, C control, LO-CM low osmolal contrast medium, ia intraarterial, iv intravenously, d days, h hours, H hydration
Table S7: Meta-analyses and two randomized controlled trials not included in the meta-analyses evaluating the renal protective effect of
theophylline
Author
year
Study
Design
Evidence
(A-C)
Metaanalysis
C
Clinical setting
Intervention
Hydrati
on
Nr
trials or
patients
Endpoints
Positive results
Renal
protection
Clinical
Improve
ment
Intravascular
contrast
varying
7 trials
480
Difference in
SCr (placebo
minus treatment)
11.5 mol/l
CI 5.3-19.4 p = 0.004
yes
no
Metaanalysis
B
Intravascular
contrast
varying
9 trials
295
290
Incidence of CIN
no
Metaanalysis
A
Intravascular
contrast
varying
6 trials
270
261
OR 0.40 (0.14-1.16)
p = 0.09
15.2 μmol/L
CI 24.6 to 5.7 p=0.002
RR 0.49 (CI 0.23-1.06)
no
Kelly AM
2008 [36]
 theo- or
aminophylline
 placebo or
control
 theo- or
aminophylline
 placebo or
control
 theo- or
aminophylline
 placebo or
control
no
no
Huber W
2006 [37]
RCT
C
ICU patients
> 100 ml iv
contrast

bedside
91
Incidence of CN




yes
no
Krämer BK
2002 [38]
RCT
C
Cardiac surgery
normal renal
function
bedside
28
ΔSCr >0.4mg/dl


no
no
Ix JH
2004 [34]
Bagshaw SM
2005 [35]
T 200 mg
iv
 NAC 2x600mg iv
starting day before
 T+ NAC
 theophylline
4 mg/kg iv,
0.25 mg/kg/h 96 h
 saline
Difference in
SCr 48h
Risk of AKI
28
RCT randomized controlled trial, SCr serum creatinine, NAC N-acetylcysteine, RPF renal plasma flow
T 2%
NAC 12%
T+NAC 4%
T vs. NAC:
p=0.047
T 18%
saline 14%
yes
Table S8: Randomized controlled studies evaluating the renal protective effect tight glycemic control
Author
Design
year
Evidence (A-C)
Van den Berghe G RCT
2001 [39]
Clinical setting
N patients
endpoints
(N trials)
Surgical ICU
A
Van den Berghe G RCT
Intervention
Medical ICU
Results
Renal benefit
(TGC vs control)
TGC
765
RRT
4.8% vs 8.2% (p0.007)
yes
control
783
AKI
9.0% vs 12.3% (p0.04)
yes
TGC
595
RRT
19.8 vs 19.8% (NS)
no
control
605
AKI
5.9 vs 8.9% (p0.04)
yes
2006 [40]
A
Brunkhorst F
RCT
Severe sepsis/
TGC
247
RRT
27.5% vs 22.5% (p0.19)
no
2008 [3]
A
septic shock
control
290
AKI
31.1% vs 26.6% (p0.25)
no
Arabi YM
RCT
Mixed ICU
TGC
266
RRT
11.7% vs 12.4% (p0.54)
no
2008 [41]
A
control
257
De Le Rosa G
RCT
TGC
254
RRT
10.8 vs 13% (p0.45)
no
2008 [42]
A
control
250
AKI
12.6 vs 10% (p0.36)
no
Finfer S
RCT
TGC
3010
RRT
15.4% vs 14.5%
no
2009 [43]
A
control
3012
Wiener RS
Meta-analysis
TGC
3629
RRT
RR 0.96 (0.76-1.2)
no
control
(9)
2008 [44]
Mixed ICU
Mixed ICU
RCT = randomized controlled trial, TGC = tight glycemic control, RRT = need for renal replacement therapy, AKI = acute kidney injury defined
as doubling of serum creatinine.
Table S9: Recent Meta-analyses evaluating the effect of N-Acetyl Cysteine (NaC) on contrast induced nephropathy (CIN)
Author
year
Kelly AM
2008 [36]
Gonzales DA
2007 [45]
Study
Design
Level
(A=C)
Metaanalysis
B
Metaanalysis
A
Clinical setting
Intervention
Nr
trials or
patients
Endpoints
Results
Renal protection
Clinical improvement
Prevention CIN
 NaC
 placebo/control
26
3393
Development
CIN
OR 0.62 (CI 0.44-0.88)
yes
no
Prevention CIN
Cluster analysis
 NaC
Development
CIN
Prevention CIN
 NaC
 placebo/control
22
2746
18
2445
4
301
28
3604
Prevention CIN


NaC
Placebo/contro
l
 NaC
 Placebo/control
13
1892
Development
CIN
OR 0.68 (CI 0.46-1.01)
no
no
14
1584
Development
CIN
OR 0.57 (CI 0.37-0.84)
yes
no
Prevention CIN
 NaC
 Placebo/control
15
1776
Development
CIN
OR 0.65 (CI 0.430.1.00)
no
no
Prevention CIN
 NaC
 Placebo/control
8
885
Development
CIN
OR 0.41 (CI 0.22-0.79)
yes
no
 Cluster 1
 Cluster 2
Gawenda M
2007 [46]
Zagler A
2006 [47]
Duong MH
2005 [48]
Pannu N
2004 [49]
Alonso A
2004 [50]
Metaanalysis
A
Metaanalysis
A
Metaanalysis
A
Metaanalysis
A
Metaanalysis
A
Prevention CIN
CIN contrast induced nephropathy
no
OR 0.87 (CI 0.68-1.12)
no
OR 0.15 (CI 0.07-0.33)
yes
Development
CIN
OR 0.69 (CI 0.57-0.82)
yes
no
Table S10. Randomized controlled studies evaluating the renal protective effect of N-Acetyl Cysteine in patients on ICU
Author
year
Ristikankare A
2006 [51]
Study
Design
Evidence
(A-C)
RCT
C
Burns KE
2005 [52]
RCT
B
Macedo E
2006 [53]
RCT
C
Komisarof JA
2007 [54]
RCT
B
Sisillo E
RCT
Clinical setting
Intervention
Nr of
patients
Endpoints
Positive results
Renal protection
Clinical
Improv
ement
Mild to moderate
CRF undergoing
Cardiopulmonary
bypass
 Iv NAC at
induction and up to
20 hours post op
 placebo
77
Urinary NAG/
Creatinine Ratio
Cystatin C
None
None (p = 0.081)
None levels > 1.4 in
78.9 vs 61.5% p =
0.096
None 42.1 vs 48.7%
(p = 0.56)
None
None
None
29.7 vs 29% (OR
1.03 (0.72-1.46)
p = 0.89
None
At risk patients
(CRF, ≥70 yrs,
DM, poor LV)
undergoing
Cardiopulmonary
bypass
Elective AAA
repair
Stable renal
function
> 30 minutes
new onset
hypotension
Patients with
Increase in SCr >
44μmol/l or > 25%
baseline
Increase in SCr >
44μmol/l or > 25%
baseline
 iv NAC (600mg x
4 doses)
 placebo or
control
295
 NAC 2x1200mg
po starting day
before
 Iv NaC 600mg x
4
 Placebo
 Oral/NG NAC 3.0
g bolus
 Then 1.5g x 8
doses
 Then 1.2g x 8
doses
 Iv NAC 1.2 g x 4
42
Increase in SCr >
44μmol/l or > 25%
baseline
ICU Mortality
ICU LOS
None
None
50% vs 27.3%
p = 0.16
None p = 0.29
None p = 0.4
None
142
Increase in SCr >
0.5mg/dl
None
None
15.5 vs 16.9%
p = 0.82
None
None
None
None
None
254
ICU Mortality
ICU LOS
Need for RRT
Increase in SCr >
Decreased need
None
2008 [55]
Adabag AS
2008 [56]
Wijeysundera
DN 2007 [57]
Molnar Z
1999 [58]
B
RCT
B
RCT
B
RCT
C
CrCl < 60
ml/min
undergoing
Cardiopulmonary
bypass
44μmol/l or > 25%
baseline
doses
Patients with
chronic kidney
disease
undergoing
cardiac surgery
 Iv NAC 600mg
bd for 7 days
Patients with
CrCl < 60
ml/min
undergoing
Cardiopulmonary
bypass
 Iv NAC
100mg/kg bolus
followed by
20mg/kg/hr for 4
hours
177
2 or more organ
failure
 Iv NAC 150
mg/kg bolus
followed by 12
mg/kg/hr infusion
for 3-5 days
86
102
ICU Mortality
ICU LOS
Need for RRT
Maximum change
in SCr from
baseline
ICU Mortality
ICU LOS
Need for RRT
%age change in
GFR during first
72 hours
Increase in SCr >
44μmol/l or > 25%
baseline
Need for RRT
ICU LOS
ICU Mortality
ICU Mortality
Inotropes (days)
MV (days)
ICU LOS (days)
ICU Mortality
for prolonged MV
in NAC group ( 3
vs 18% p = 0.001)
ICU stay > 4 days
reduced (13 vs
33% p = 0.001)
None
ICU mortality
reduced in NAC
treated group
0 vs 8%
P = 0.007
None
40 vs 52%
p = 0.06
None
None
None
0.45 +/- 0.7 mg/dL
(NAC) vs 0.55 +/- 0.9
mg/dL (placebo)
p = 0.53)
p = 1.0
None
p = 0.68
5.2% improved in
NAC group
CI 2.4-12.1%)
None
None
28 vs 32%
OR 0.84 (0.42-1.68)
p = 0.59
p = 0.37
p = 0.42
11 vs 26% (p = 0.23)
1.5(0-3) vs 3(1-5)
p = 0.07
4(2-6) vs 4(3-9)
P = 0.21
5(4-10) vs 8(4-13)
P = 0.30
None
RCT randomized controlled trial, NAG Urine N-acetyl-β-D-glucosaminidase, SCr serum creatinine, NAC N-acetylcysteine, MV mechanical
ventilation, LOS length of stay. ICU intensive care unit..
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