When should we start renal-replacement therapy in critically ill patients with acute kidney injury: do we finally have the answer?

• Published in: Critical care (London, England) Vol. 25; no. 1; pp. 1 - 179
• Main Authors: Bagshaw, Sean M, Hoste, Eric A, Wald, Ron
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 26-05-2021; BioMed Central; BMC
• Subjects: Acute renal failure; Anuria; Care and treatment; Critical care; Critically ill; Delirium; Illnesses; Intensive care; Kidneys; Machine learning; Mortality; Patients; Renal replacement therapy; Canada
• ISSN: 1364-8535; 1364-8535; 1366-609X; 1466-609X
• DOI: 10.1186/s13054-021-03600-x

[...]small and unblinded trials would be susceptible to biased co-interventions, such as withdrawal of life-sustaining treatments. Of the 4,466 initially excluded, 42.9% failed to achieve Stage 3 AKI and many were excluded for urgent indications (13.5%) or prior RRT (6.8%). [...]of those with Stage 3 AKI who were excluded, 127 (26.0%) developed an urgent indication after a median (IQR) of 35 (17–68) hours and received RRT, while the remainder did not fulfil randomization criteria. [...]serum urea is influenced by a range of factors other than impaired excretion, including excess protein catabolism, corticosteroid administration, exogenous protein or gastrointestinal bleeding and volume contraction. [...]the thresholds of serum urea did not discriminate patients with urgent indications for RRT: 16.6% of Stage 3 AKI patients had urgent indications developed prior to the delayed criteria being fulfilled, and 33% of patients in the more-delayed strategy developed urgent indications prior to the protocolized serum urea threshold (> 50 mmol/L) was fulfilled.