Chapter 5.1: Timing of renal replacement therapy in AKI

Whether or not to provide RRT, and when to start, are two of the fundamental questions facing nephrologists and inten-sive-care practitioners in most cases of severe AKI. In recent publications, the timing of initiation of RRTwas listed as one of the top priorities in research on AKI.524 However, this dimension has not been included as a factor in any of the large RCTs in this area. The optimal timing of dialysis for AKI is not defined. In current practice, the decision to start RRT is based most often on clinical features of volume overload and biochemical features of solute imbalance (azotemia, hyperkalemia, severe acidosis). However, in the absence of these factors there is generally a tendency to avoid dialysis as long as possible, a thought process that reflects the decisions made for patients with CKD Stage 5. Clinicians tend to delay RRT when they suspect tha