Changes in Diabetes-Related Complications in the United States, 1990–2010

n engl j med 371;3 nejm.org july 17, 2014 284 was most likely to have been infrequent. Finally, for the study to be methodologically rigorous, stratification of the patients according to the presence or absence of intraabdominal hypertension would have been mandatory at inclusion, with a risk of an underpowered subsequent analysis. We agree with Kimmoun et al. that our results are limited with regard to the vasopressors used; we used norepinephrine. Targeting a high mean blood pressure with the use of epinephrine or dopamine might have caused an increase in the incidence of adverse effects such as newonset arrhythmia1 or lactic acidosis.2 In contrast, one might speculate that infusing vasopressin to increase the mean blood pressure might have been associated with opposite findings: in patients with catecholamine-resistant vasodilatory shock, vasopressin significantly decreased the incidence of a new onset of atrial fibrillation,3 and a post hoc analysis of the Vasopressin and Septic Shock Trial showed a reduced progression to renal failure in vasopressin-treated patients at risk for kidney injury.4 Pierre Asfar, M.D., Ph.D.