When to initiate RRT in patients with AKI – Does timing matter?

Acute kidney injury is a serious illness which occurs commonly in the renal units and also in the ICU setting. It is an independent risk factor of increased mortality and morbidity, particularly when RRT is needed. The wide variation in utilization of RRT contributes to a lack of consensus among clinicians regarding the parameters which should guide the decision to initiate RRT. This problem is confounded by a paucity of high quality evidence in the current literature. This review examines the role of usual biochemical parameters as well as conventional clinical indications for commencing RRT. It also discusses the potential role of biomarkers as predictors for the need of RRT in AKI. Initiating dialysis in AKI should be based on dynamic clinical criteria and not only on specific biochemical values.