When Should We Initiate Hemodialysis in Critically Ill Patients with Acute Kidney Injury?

When should hemodialysis be started for a critically ill patient? Previous small trials and a meta-analysis have yielded mixed messages. Early hemodialysis lowers inflammatory mediators, maintains acid-base equilibrium, and helps avoid volume overload; however, if dialysis is started too early, some patients who would never need it are exposed to its potential complications.

In a single-center study from Germany, investigators randomized 231 critically ill postoperative patients with stage 2^* KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (AKI) to early (within 8 hours of reaching stage 2) or delayed continuous renal replacement therapy. Specific criteria (e.g., progressive oliguria/anuria, severe hyperkalemia, uremia)…