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Randomised controlled trial
In critically ill patients with acute kidney injury stage 2, early initiation of renal replacement therapy is associated with reduced 90-day mortality compared to delayed initiation
  1. Marlies Ostermann
  1. Correspondence to Dr Marlies Ostermann, Department of Critical Care & Nephrology, Guy's & St Thomas' NHS Foundation Hospital, Westminster Bridge Road, London SE1 7EH, UK; Marlies.Ostermann{at}gstt.nhs.uk

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Clinical practice of acute renal replacement therapy (RRT) is variable. In particular, the optimal threshold for starting RRT remains uncertain. Early initiation may lead to more rapid correction of electrolyte and metabolic derangements, mitigate fluid overload and prevent serious complications but has to be balanced against potential harm from vascular access, anticoagulation and haemodynamic instability.1 Early RRT also has resource implications and may result in patients receiving RRT unnecessarily. Data from observational studies and small clinical trials with variable criteria for ‘early’ and ‘late’ suggest that early initiation may be better, but results from randomised controlled trials (RCTs) are conflicting.2 …

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