Context

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 …