Timing of Dialysis in Patients with Acute Kidney Injury

Does early initiation of dialysis benefit patients with acute kidney injury (AKI)? To find out, researchers at a tertiary center in India evaluated 208 patients with “community-acquired” AKI who presented with progressively worsening renal function. The most common causes were sepsis, acute gastroenteritis, malaria, drugs, and undifferentiated acute febrile illnesses. Patients were randomized to begin intermittent hemodialysis either when serum creatinine level exceeded 7 mg/dL (unless a compelling indication for earlier dialysis occurred) or when dialysis was required to manage refractory hyperkalemia, volume overload, acidosis, or uremic nausea (usual care).

Mean serum creatinine levels at dialysis initiation were 7.4 mg/dL in the early gr…