Have we reached the limit of mortality benefit with our approach to renal replacement therapy in acute kidney injury?

摘要

In this issue of AMD, Jamale et al tackle one of the most difficult and important issues regarding renal replacement therapy (RRT) in acute kidney injury (AKI): the timing of the therapy. The question of when to start RRT has troubled nephrologists for well over a half century and is widely viewed as a top research priority in the field of AKI. The study by Jamale et al is an important step forward to answering this question due to the high quality of the trial design. In this study, 208 patients with community-acquired AKI were randomly assigned to early- versus usual-start RRT (intermittent hemodi-alysis). Early-start RRT was initiated at a serum urea nitrogen (SUN) level > 70 mg/dL and/or a serum creatinine level > 7.0 mg/dL; usual-start RRT was initiated when complications occurred (eg, refractory hyperkalemia, volume overload, acidosis, nausea, and anorexia).