January 31, 2018


Effects of timing of renal replacement therapy in ICU patients with AKI



Acute kidney injury (AKI) is common in the intensive care and the need for renal replacement therapy (RRT) is a common sequelae. The best timing of RRT initiation in such patients is still unclear and whether to start RRT early after AKI or late remains a question.

The authors performed this cohort study to examine the impact of early RRT on long-term mortality, risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD). They analysed patients who were treated in the ICU of Aarhus University Hospital in Denmark between 2005 and 2015. Data was extracted from the clinical information system (CIS) database where early RRT was defined as starting at AKI stage 2 or below and late RRT as starting at AKI stage 3.

Results showed that 90-day mortality was higher in the early RRT than the late RRT group (52.5% vs. 45.6%). However, 5 year mortality was found higher in the late RRT group versus the early RRT group (41.1% vs. 37.7%). There was no difference between the two groups regarding the development of CKD or ESRD. They concluded that those findings do not support that early RRT initiation is superior to late initiation.

The main limitation of the study is that a large number of patients did not have a baseline creatinine measurement, which meant that they used a MDRD equation to estimate it, however not all patients had information about their urine output, hence those patients were staged using only a creatinine ratio, which might have led to a misclassification of AKI stage.

Take Home Messages

  • Early RRT was associated with higher short-term mortality.
  • There was no association between timing of RRT initiation and long-term outcomes including 5 year mortality, CKD and ESRD.
  • The early initiation of RRT is not superior to late RRT.

Article review was prepared and submitted by NEXT EJRC member Mohamed Omar Elghonemi, Department of Critical Care, University of Cairo, Egypt.


Christiansen S et al. Timing of renal replacement therapy and long-term risk of chronic kidney disease and death in intensive care patients with acute kidney injury. Crit Care. 2017 Dec 28;21(1):326. doi: 10.1186/s13054-017-1903-y.

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