Longer delay of RRT does no good for critically ill severe AKI patients: Study

France: Longer postponement of renal replacement therapy (RRT) did not confer any additional benefit and is indeed harmful in critically ill patients with severe acute kidney injury (AKI) and no severe complication, finds a recent study in the journal Lancet.

Delaying RRT for some time in critically ill patients with severe AKI and no severe complication is safe and allows optimization of the medical devices use. However, there remains uncertainty on the duration for which RRT can be postponed without risk. Prof Stéphane Gaudry, Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France, and colleagues aimed to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy.

For this purpose, the researchers performed an unmasked, multicentre, prospective, open-label, randomised, controlled trial in 39 intensive care units in France. Critically ill patients with severe AKI (defined as Kidney Disease: Improving Global Outcomes stage 3) were monitored until they had oliguria for more than 72 h or a blood urea nitrogen concentration higher than 112 mg/dL. 

Patients were randomly assigned in the ratio 1:1 to receive either a strategy (delayed strategy) in which RRT was started just after randomization or to a more-delayed strategy. With the more-delayed strategy, RRT initiation was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen concentration reached 140 mg/dL.