No Mortality Benefit for Early Renal Replacement Therapy in Patients with Septic Shock

The timing of renal replacement therapy (RRT) initiation for critically ill patients with acute kidney injury (AKI) remains a subject of debate, with disparate results from two recent trials (NEJM JW Gen Med Jul 15 2016 and N Engl J Med 2016; 375:122 and JAMA 2016; 315:2190). To look at this question again, French investigators randomized 488 patients with septic shock to either start RRT within 12 hours (early arm) or to delay RRT until 48 hours after developing AKI (unless severe hyperkalemia, metabolic acidosis, or fluid overload was present). Patients had to be on vasopressors for no longer than 48 hours. AKI criteria included anuria for 12 hours, oliguria (≤0.3 mL/kg/hour for >24 hours), or tripling of creatinine from baseline with an …