- In the absence of emergency indications:
- Current evidence does not firmly confirm advantages of either an early or late initiation of RRT
- Most evidence supports the use of a “wait and see” attitude without leading to worse outcomes
- Patient should be considered as a whole (Table adapted from Macedo et al):
Severity of Illness & Trajectory
- AKI severity and trend
- Severity of electrolyte and acid base disorder
- Fluid balance and symptoms of overload
- Presence of other organ dysfunction impacted by AKI / fluid overload
Necessity of RRT
- Likelihood of early recovery of kidney function without RRT
- Underlying comorbidities impacted by AKI / fluid overload
- Associated acute organ dysfunction
Risks of RRT
- Vascular access
- Haemodynamic instability
- Infection
- Clearance of trace elements / vitamins / drugs
- Immobilisation
Other Factors
- Patient and family wishes
- Overall goals of care
- Availability of machines and nursing staff
- Healthcare costs