Late vs Early Dialysis Probably Doesn’t Improve Outcomes in Acute Kidney Injury

Background:  Timing of renal replacement therapy (RRT) for severe AKI is controversial.
Canadian study of n = 100 patients hospitalized with oliguric severe AKI but without urgent indications for RRT (e.g., severe acidosis, hyperkalemia).
Randomized to early RRT – started within 12 h of randomization – or standard care (waiting for classic indications to develop) or physician judgment.
Accelerated group had mean Cr of 3.7 when RRT started.
Standard care group – 63% eventually got RRT.
No difference in in-hospital mortality, 90d mortality, LOS or RRT dependence at 90 d.
Conclusions:  Suggests that delaying RRT until classic indications develop will probably not lead to worse outcomes.  Another study (n = 208) also concluded that early RRT did not improve outcomes (Am J Kidney Dis 2013; 62:1116).
Kidney Int 2015 Oct; 88:897

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