Renal Replacement Therapy in the Intensive Care Unit

Critical care providers continue to struggle with finding the right time to start renal replacement therapy (RRT) for intensive care unit (ICU) patients. A growing body of literature offers conflicting results. In 2018, investigations focused on specific patient populations to assess whether a more-targeted approach to RRT could provide definitive guidance.

In a previously published trial, ICU patients with acute kidney injury (AKI stage 3, defined by serum creatinine and urine output criteria) who required mechanical ventilation or pressors were randomized to receive either early or delayed RRT, with specific criteria for initiation of delayed RRT (NEJM JW Gen Med Jul 15 2016 and N Engl J Med 2016; 375:122). Now, in a 2018 post hoc analysis…