Introduction
critically ill, acute lung edema, renal failure, hyperkalemia, metabolic acidosis, AKI, Kidney Injury, acute kidney injury
CRITICALLY ILL, RENAL FAILURE, KIDNEY, SEPTIC SHOCK, METABOLIC ACIDOSIS, COMPLICATIONS
Despite the frequent use of renal replacement therapy (RRT) in the intensive care units (ICUs) for critically ill patients with severe acute kidney injury (AKI), precise criteria for initiation of RRT are still not available. In the absence of life-threatening complications, clinicians have long been uncertain about when to initiate renal replacement therapy. Theoretically, earlier RRT initiation could improve electrolyte and acid–base control as well as fluid balance [Three recent multicenter randomized controlled trials including a total of more than 4000 patients have explored the question of the timing of RRT initiation, namely the AKIKI (Artificial Kidney Initiation in Kidney Injury) trial [The main message to emerge from the results of these three studies is that, in the absence of emergency criteria (such as hyperkalemia, metabolic acidosis or acute lung edema), there is no benefit in terms of mortality to be gained from immediate initiation of RRT in patients with KDIGO stage 2–3 AKI. On the contrary, deferring initiation of RRT enabled many patient to avoid RRT (between 38 [The question of the benefit to be gained from early RRT initiation remains open. The conclusions of these studies may have been shaped by the choice of inclusion criteria, which did not correctly identify the patients with the most severe forms of renal failure and, thus, those who might potentially benefit most from earlier initiation of RRT. We hypothesized that the severity of AKI is different in patients in whom AKI diagnosis was based solely on creatinine elevation, compared to patients in whom AKI is diagnosed on the basis of a reduction of urine output alone, or those with both criteria. We further hypothesize that the impact of early initiation of RRT may be different across these groups.In this context, we performed a post hoc subanalysis among patient from the randomized IDEAL-ICU trial, to assess whether there is a differential effect of the timing of RRT initiation on 90-day mortality, according to the KDIGO criteria used to diagnose acute kidney injury (AKI), in patients with early-stage septic shock.