Early Initiation
- May confer benefit, in particular in circumstances in which there is a perception that recovery from AKI is not imminent
- Can theoretically facilitate more rapid correction of electrolyte and acid-base derangements and control of uraemia and mitigate fluid accumulation
- Would prevent the occurrence of overt complications of AKI
- May limit worsening of non-renal organ dysfunction (potential kidney-organ interactions)
- Will result in initiation of RRT in a significant portion of patients who may have regained renal function with conservative management
Late Initiation
- Has not been shown to lead to worse outcomes than early initiation
- Prevents complications of RRT in subset of patients that did not require it:
- Insertion of dialysis catheters
- Exposure to extracorporeal circuits
- Clearance of nutrients and medication
- Iatrogenic haemodynamic instability
- Reduces healthcare costs by limiting bedside workload and resource utilisation