Intervention
Population
Conclusion

RCT: ELAIN

Zarbock et al
JAMA (2016)

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  • Early vs. Late initiation of RRT
  • Early: Within 8 hours of meeting KDIGO stage 2 AKI
  • Late: Within 12 hours of meeting KDIGO stage 3 AKI or emergency indication
  • 231 patients with AKI and either severe sepsis or requiring catecholamine infusion
  • Early group showed significantly lower mortality at 90 days (39.3% vs. 54.7%, p=0.03)
The Bottom Line Review

RCT: AKIKI

Gaudry et al
NEJM (2016)

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  • Early vs. Late initiation of RRT
  • Early: Immediately upon meeting KDIGO stage 3 AKI criteria
  • Late: If oliguric 72 hours after meeting KDIGO stage 3 AKI criteria or emergency indications
  • 620 patients with AKI requiring mechanical ventilation or catecholamine infusion
  • No difference in mortality between early and late group (48.5% vs 49.7%, p=0.79)
  • In delayed group 49% did not require RRT
The Bottom Line Review

RCT: IDEAL-ICU

Barbar et al
NEJM (2018)

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  • Early vs. Late initiation of RRT
  • Early: within 12-hours of meeting failure by RIFLE criteria
  • Late: after 48-hours of meeting failure by RIFLE criteria if no renal recovery or emergency indications
  • 488 patients with severe AKI and septic shock
  • No difference in mortality between early and late group (58% vs 54%, p=0.38)
  • In delayed group:
    • 38% did not require RRT
    • 17% met indications for emergency RRT
    The Bottom Line Review