•  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