Timing of RRT initiation in critically-ill patients: time for precision medicine

Recently published randomized controlled trials have brought a focus upon the timing of renal replacement therapy (RRT) initiation in critically-ill patients (1,2). The AKIKI study randomized 620 ICU patients with severe acute kidney injury (AKI) [kidney disease improving global outcomes (KDIGO) classification, stage 3] to either immediate initiation of RRT or delayed initiation according to predetermined mandatory RRT criteria (1). Gaudry et al . found no significant difference in mortality between early and delayed RRT initiation strategies in critically-ill patients results, suggesting that careful monitoring of patients for predetermined mandatory RRT criteria may safely allow delaying RRT in ventilated and/or catecholamine-dependent patients with severe AKI.