Timing of Kidney Support Therapy in Acute Kidney Injury: What Are We Waiting For?
Am J Kidney Dis
; 79(3): 417-426, 2022 03.
Article
in En
| MEDLINE
| ID: mdl-34461167
ABSTRACT
The optimal timing of kidney support therapy in critically ill patients with acute kidney injury (AKI) without life-threatening complications related to AKI is controversial. Recent multicenter, randomized, controlled studies have questioned the need for earlier initiation of therapy, despite one study showing a benefit in survival and others with no differences in mortality based on the timing of kidney support therapy initiation. These findings reflect the uncertainties in decisions to initiate kidney support therapy, which should ideally be individualized according to the patient's comorbidities, severity of illness, trajectory of kidney function, and urine output as well as requirements for fluid balance and solute removal. A delayed approach could translate into a potentially reduced burden of dialysis dependence in addition to saving health resources. However, we must ascertain what constitutes the waiting period and the benefits and risks associated with this approach. This article reviews the concept of timing of dialysis in AKI, performs a critical assessment of the most important clinical trials in this topic, discusses ongoing research and knowledge gaps, and defines key research issues to address in the future.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Renal Replacement Therapy
/
Acute Kidney Injury
Type of study:
Clinical_trials
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
Am J Kidney Dis
Year:
2022
Type:
Article
Affiliation country:
Canada