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

Acute kidney injury (AKI) affects many intensive care unit patients and is responsible for increased morbidity and mortality. Although life-saving 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 (RCT). Recent RCTs 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...