Optimising the timing of renal replacement therapy in acute kidney injury

Matthew E Cove; Graeme MacLaren; Daniel Brodie; John A Kellum

doi:10.1186/s13054-021-03614-5

Optimising the timing of renal replacement therapy in acute kidney injury

Crit Care. 2021 May 31;25(1):184. doi: 10.1186/s13054-021-03614-5.

Authors

Matthew E Cove¹, Graeme MacLaren², Daniel Brodie^{3

4}, John A Kellum⁵

Affiliations

¹ Department of Medicine, National University Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore. mdcmec@nus.edu.sg.
² Cardiothoracic ICU, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
³ Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA.
⁴ Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
⁵ Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, 606 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.

Abstract

The optimal timing of renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) has been much debated. Over the past five years several studies have provided new guidance for evidence-based decision-making. High-quality evidence now supports an approach of expectant management in critically ill patients with AKI, where RRT may be deferred up to 72 h unless a life-threatening indication develops. Nevertheless, physicians' judgment still plays a central role in identifying appropriate patients for expectant management.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Intensive care.

MeSH terms

Acute Kidney Injury / therapy*
Critical Illness / therapy
Humans
Renal Replacement Therapy / methods*
Renal Replacement Therapy / standards
Renal Replacement Therapy / statistics & numerical data
Time Factors*