Timing of Renal Replacement Therapy for Severe Acute Kidney Injury in Critically Ill Patients

American Journal of Respiratory and Critical Care Medicine
Stéphane GaudryDidier Dreyfuss

Abstract

Acute kidney injury (AKI) affects many ICU patients and is responsible for increased morbidity and mortality. Although lifesaving in many situations, renal replacement therapy (RRT) may be associated with complications, and the appropriate timing of its initiation is still the subject of intense debate. An early initiation strategy can prevent some metabolic complications, whereas a delayed one may allow for renal function recovery in some patients without need for this costly and potentially dangerous technique. For years, most of the knowledge on this issue stemmed from observational studies or small randomized controlled trials. Recent randomized controlled trials have indicated that a watchful waiting strategy (in the absence of life-threatening conditions such as severe hyperkalemia or pulmonary edema) during severe AKI allowed many patients to escape RRT and did not seem to adversely affect survival compared with a strategy of immediate RRT. In addition, data suggest that a delayed strategy may reduce the rate of complications (such as catheter infection) and favor renal function recovery. Ongoing studies will have to both confirm these conclusions and clarify to what extent the delay in initiating RRT can be prolonged. P...Continue Reading

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Citations

Dec 14, 2019·Intensive Care Medicine·N BenichouD Dreyfuss
Jan 10, 2020·American Journal of Respiratory and Critical Care Medicine·Natalja L StanskiHector R Wong
May 17, 2019·American Journal of Respiratory and Critical Care Medicine·Stéphane GaudryDidier Dreyfuss
May 17, 2019·American Journal of Respiratory and Critical Care Medicine·Benjamin G ChoustermanRomain Barthélémy
Oct 8, 2020·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Valentine A Lobo
Jun 2, 2021·Critical Care : the Official Journal of the Critical Care Forum·Matthew E CoveJohn A Kellum

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Methods Mentioned

BETA
Replacement Therapy

Clinical Trials Mentioned

NCT02669589
NCT02568722
NCT03396757

Software Mentioned

ELAIN
AKIKI
AKI
ICU
IDEAL
STARRT
HEROICS

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