
In a systematic review and meta-analysis (Karvellas et al. Critical Care 2011, 15:R72), it was suggested that early institution of RRT in critically ill patients with AKI may have a measurable benefit on survival. However, most studies were smaller studies with important differences in design and quality, and only two randomised trials.
In this multicenter, randomized, controlled trial by Barbar et al, they randomized 488 patients with sepsis and acute renal failure to eaither early CRRT (12 hours) or late (after 48 hours). The study was stopped early for futlity. 58% of the patients in the early-strategy group (138 of 239 patients) and 54% in the delayed-strategy group (128 of 238 patients) had died (P=0.38).
It is widely accepted that if there are life-threatening complications of acute kidney injury, such as hyperkalemia or metabolic acidosis, renal-replacement therapy should be initiated immediately. However, in the absence of such complications, there is no convincing evidence that outcome might be better if renal-replacement therapy was initiated early.
Article Source: N Engl J Med 2018; 379:1431-1442. DOI: 10.1056/NEJMoa1803213 |