Initiation of Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

When should renal replacement therapy (RRT) be initiated in critically ill patients with severe acute kidney injury (AKI)? Early initiation allows rapid correction of metabolic abnormalities, whereas delayed initiation might allow RRT to be avoided entirely. To avoid bias, randomized trials must include strict criteria for starting RRT in the delayed-initiation group, so that patients who never receive RRT can be included in the analysis. Several such trials have been done, but their statistical power has been debated.

Researchers performed a meta-analysis of individual patient data from eight recent randomized trials in which early and delayed initiation of RRT (e.g., dialysis, hemofiltration) were compared in ≥1600 critically ill adult pat…