Article Text

Download PDFPDF
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}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Commentary on: OpenUrlCrossRefPubMed.


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 …

View Full Text


  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.