title: Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions.
abstract: Patients with acute kidney injury (AKI) often require initiation of renal replacement therapy (RRT). Currently, there is wide variation worldwide on the indications for and timing of initiation and discontinuation of RRT for AKI. Various parameters for metabolic, solute, and fluid control are generally used to guide the initiation and discontinuation of therapy; however, there are currently no standards in this field. Members of the recently established Acute Kidney Injury Network, representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI, participated in a 3-d conference in Vancouver in September 2006 to evaluate the available literature on this topic and draft consensus recommendations for research studies in this area. Key questions included the following: what are the indications for RRT, when should acute RRT support be initiated, and when should RRT be stopped? This report summarizes the available evidence and describes in detail the key questions, and some of the methods of answering them that will need to be addressed with the goal of standardizing the care of patients with AKI and improving outcomes.
authors.affiliation: Division of Critical Care Medicine, 3C1.16 University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada T6G 2B7. ngibney@ualberta.ca
authors.forename: Noel
authors.initials: N
authors.lastname: Gibney
authors.forename: Eric
authors.initials: E
authors.lastname: Hoste
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Burdmann
authors.forename: Timothy
authors.initials: T
authors.lastname: Bunchman
authors.forename: Vijay
authors.initials: V
authors.lastname: Kher
authors.forename: Ravindran
authors.initials: R
authors.lastname: Viswanathan
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D058186:Acute Kidney Injury / Q000378:metabolism / Q000628:therapy*; D035843:Biomedical Research / Q000458:organization & administration*; D003661:Decision Support Techniques; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016730:Program Development; D011787:Quality of Health Care / Q000592:standards; D017582:Renal Replacement Therapy / Q000592:standards; D009626:Terminology as Topic; D013997:Time Factors