TY - JOUR
T1 - Timing of renal replacement therapy in critically ill patients with acute kidney injury
AU - Bouman, Catherine S.C.
AU - Oudemans-Van Straaten, Heleen M.
PY - 2007/12/1
Y1 - 2007/12/1
N2 - PURPOSE OF REVIEW: Timing of renal replacement therapy in critically ill patients with acute kidney injury is highly subjective, and may influence outcome. We discuss renal and nonrenal criteria for timing considering the recent literature. RECENT FINDINGS: Two randomized and four nonrandomized controlled trials investigated the effects of timing on patient outcome. All but one randomized controlled trial indicated better outcome with early renal replacement therapy but had poor methodological quality. The heterogeneity of timing definition, study population and mode of therapy, however, hampered comparison among studies. SUMMARY: In the absence of large randomized controlled trials we can make no firm recommendations for timing of renal replacement therapy in acute kidney injury. Since rapid recovery of renal function is unlikely when other organ failure persists and the consequences of acute kidney injury may be more severe in critically ill patients, we suggest other organ failure is also considered. Patients with acute kidney injury, persisting shock and poorly recovering functions of other organs may benefit from early therapy. For future studies, we recommend describing renal replacement therapy timing according to the 'RIFLE' classification, as modified by the Acute Kidney Injury Network, and quantifying the severity of other organ failure. Biomarkers may refine acute kidney injury and timing definitions in the future.
AB - PURPOSE OF REVIEW: Timing of renal replacement therapy in critically ill patients with acute kidney injury is highly subjective, and may influence outcome. We discuss renal and nonrenal criteria for timing considering the recent literature. RECENT FINDINGS: Two randomized and four nonrandomized controlled trials investigated the effects of timing on patient outcome. All but one randomized controlled trial indicated better outcome with early renal replacement therapy but had poor methodological quality. The heterogeneity of timing definition, study population and mode of therapy, however, hampered comparison among studies. SUMMARY: In the absence of large randomized controlled trials we can make no firm recommendations for timing of renal replacement therapy in acute kidney injury. Since rapid recovery of renal function is unlikely when other organ failure persists and the consequences of acute kidney injury may be more severe in critically ill patients, we suggest other organ failure is also considered. Patients with acute kidney injury, persisting shock and poorly recovering functions of other organs may benefit from early therapy. For future studies, we recommend describing renal replacement therapy timing according to the 'RIFLE' classification, as modified by the Acute Kidney Injury Network, and quantifying the severity of other organ failure. Biomarkers may refine acute kidney injury and timing definitions in the future.
KW - Acute kidney injury
KW - Acute renal failure
KW - Biomarkers
KW - Multiple organ failure
KW - Renal replacement therapy
KW - Timing
UR - http://www.scopus.com/inward/record.url?scp=35848961191&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/MCC.0b013e3282f0eae2
DO - https://doi.org/10.1097/MCC.0b013e3282f0eae2
M3 - Review article
C2 - 17975386
SN - 1070-5295
VL - 13
SP - 656
EP - 661
JO - Current Opinion in Critical Care
JF - Current Opinion in Critical Care
IS - 6
ER -