Appropriate timing to start renal replacement therapy in critically ill patients with acute kidney injury: What does the scientific evidence tell us?
PDF (Español)

Keywords

Acute Kidney Injury
Critical Illness
Intensive Care Units
Renal Replacement Therapy
Mortality

How to Cite

1.
Abuabara-Franco E, Rico-Fontalvo J, Bohórquez-Rivero J, Abuabara-Sáenz AD, Lavalle-Jiménez C, Burgos-Calao J, Parra-Sánchez PA. Appropriate timing to start renal replacement therapy in critically ill patients with acute kidney injury: What does the scientific evidence tell us? . Rev. Colomb. Nefrol. [Internet]. 2024 Feb. 3 [cited 2024 Feb. 26];11(1). Available from: https://revistanefrologia.org/index.php/rcn/article/view/728

Abstract

Acute kidney injury (AKI) is a common entity in critically ill patients. It can occur in 30% to 60% of patients in the intensive care unit (ICU), conferring a poor clinical prognosis. Many critically ill patients with AKI undergo renal replacement therapy (RRT), however, in the absence of absolute indications such as acute pulmonary edema refractory to diuretics and major metabolic disorders such as uremia, acidosis and severe hyperkalemia, the optimal timing for initiation of RRT to improve clinical outcomes remains uncertain and is still a matter of debate.

In recent years, multiple studies have focused on determining the ideal timing for initiation of RRT in the setting of the critically ill patient with AKI. Several observational studies and small randomized controlled trials suggest that early initiation of RRT may improve survival; however, more recent trials have found no statistically significant difference in mortality between an early and a late strategy for initiation of RRT in critically ill patients with severe AKI.

https://doi.org/10.22265/acnef.11.1.728
PDF (Español)

References

Li X, Liu C, Mao Z, Li Q, Zhou F. Timing of renal replacement therapy initiation for acute kidney injury in critically ill patients: a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis. Crit Care. 2021;25(1):15. https://doi.org/10.1186/s13054-020-03451-y

Echeverri J, Larrarte C, Huerfano M. Continuous Renal Replacement Therapy Specialized Teams: A Challenge to Improve Quality Performance. En: Karkar A, editor. Aspects of Continuous Renal Replacement Therapy. Londres: Intech Open Limited; 2019. https://doi.org/10.5772/intechopen.79853

Castro I, Relvas M, Gameiro J, Lopes JA, Monteiro-Soares M, Coentrão L. The impact of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury on mortality and clinical outcomes: a meta-analysis. Clin Kidney J. 2022;15(10):1932-45. https://doi.org/10.1093/ckj/sfac139

Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med. 2016 jul. 14;375(2):122-33. https://doi.org/10.1056/NEJMoa1603017

Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018;379(15):1431-42. https://doi.org/10.1056/NEJMoa1803213

Fayad AII, Buamscha DG, Ciapponi A. Timing of renal replacement therapy initiation for acute kidney injury. Cochrane Database Syst Rev. 2018;12(12):CD010612. https://doi.org/10.1002/14651858.CD010612.pub2

Gaudry S, Hajage D, Benichou N, Chaïbi K, Barbar S, Zarbock A, et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet. 2020 my. 9;395(10235):1506-15. https://doi.org/10.1016/S0140-6736(20)30531-6

Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, Dreyfuss D, et al. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020 jul. 16;383(3):240-51. https://doi.org/10.1056/NEJMoa2000741

Gaudry S, Hajage D, Martin-Lefevre L, Lebbah S, Louis G, Moschietto S, et al. Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial. Lancet. 2021 abr. 3;397(10281):1293-300. https://doi.org/10.1016/S0140-6736(21)00350-0

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Dimensions


PlumX


Downloads

Download data is not yet available.