Related Experiment Video

Updated: Nov 11, 2025

Robot-Assisted Kidney Transplantation
07:30

Robot-Assisted Kidney Transplantation

Published on: July 19, 2021

3.9K

Timing of kidney replacement therapy initiation in acute kidney injury

Alejandro Y Meraz-Muñoz1, Sean M Bagshaw2, Ron Wald1

  • 1Division of Nephrology, St. Michael's Hospital and the University of Toronto, Toronto, Ontario.

Current Opinion in Nephrology and Hypertension
|March 26, 2021
PubMed
Abstract

Insights

Initiating kidney replacement therapy (KRT) early for acute kidney injury (AKI) in critical illness does not improve survival. Deferring KRT is recommended unless specific indications arise, to avoid complications.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Clinical Trials

Background:

  • Acute kidney injury (AKI) is common in critically ill patients.
  • The optimal timing for initiating kidney replacement therapy (KRT) in AKI remains a significant clinical question.
  • Recent randomized controlled trials (RCTs) have provided crucial data on this topic.

Purpose of the Study:

  • To review and synthesize findings from major RCTs on KRT initiation timing in critically ill AKI patients.
  • To discuss current knowledge gaps and future research directions.

Main Methods:

  • Systematic review of four major randomized controlled trials published within the last five years.
  • Analysis of trial designs and outcomes related to early versus delayed KRT initiation.

Main Results:

  • Three large RCTs demonstrated that early KRT initiation did not reduce all-cause mortality in critically ill AKI patients.
  • Early KRT initiation was linked to increased iatrogenic complications and, in one trial, a higher risk of dialysis dependence.
  • A preemptive KRT strategy did not improve survival in severe AKI.

Conclusions:

  • Deferring KRT initiation in AKI patients is advisable in the absence of absolute indications.
  • Further research is required to establish safe KRT deferral limits and identify triggers for initiation, such as fluid overload markers.

More Related Videos

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion09:02

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

Published on: February 2, 2021

4.7K
Murine Kidney Transplant Technique08:58

Murine Kidney Transplant Technique

Published on: October 20, 2015

16.7K

Related Concept Videos

Acute Kidney Injury III: Clinical Manifestations01:29

Acute Kidney Injury III: Clinical Manifestations

Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
401
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
113
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
127
Acute Kidney Injury I: Introduction01:22

Acute Kidney Injury I: Introduction

Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
252
Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
136
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
136