title: When to start renal replacement therapy in critically ill patients with acute kidney injury: comment on AKIKI and ELAIN.
abstract: The dilemma of whether and when to start renal replacement therapy among critically ill patients with acute kidney injury in the absence of conventional indications has long been a vexing challenge for clinicians. The lack of high-quality evidence has undoubtedly contributed decisional uncertainty and unnecessary practice variation. Recently, two randomized trials (ELAIN and AKIKI) reported specifically on the issue of the timing of initiation of renal replacement therapy in critically ill patients with acute kidney injury. In this commentary, their fundamental differences in trial design, sample size, and widely discrepant findings are considered in context. While both trials are important contributions towards informing practice on this issue, additional evidence from large multicenter randomized trials is needed.
authors: Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building 8440-112 ST, NW, Edmonton, T6G 2B7, Canada. bagshaw@ualberta.ca.
authors: Sean M
authors: SM
authors: Bagshaw
authors: Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.|Centre Hospitalier Universitaire de Sherbrooke, 3001 12e avenue N., Sherbrooke, QC, J1H 5N4, Canada.|Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
authors: François
authors: F
authors: Lamontagne
authors: Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors: Michael
authors: M
authors: Joannidis
authors: Division of Nephrology, St. Michaels Hospital, University of Toronto, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
authors: Ron
authors: R
authors: Wald
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D016638:Critical Illness / Q000628:therapy; D006801:Humans; D017582:Renal Replacement Therapy / Q000379:methods*; D012107:Research Design / Q000592:standards*; D061665:Time-to-Treatment / Q000592:standards*; D016896:Treatment Outcome
keywords: Acute kidney injury; Delayed; Dialysis; Early; Mortality; Randomized trial; Renal replacement therapy