Recommendation ID
CG169/4
Question
Introducing renal replacement therapy:- What is the clinical and cost effectiveness of early versus later introduction of renal replacement therapy in patients with acute kidney injury stages 2 and 3, when there is no urgent need for therapy?
Any explanatory notes
(if applicable)
Why this is important:- In some patients renal replacement therapy is a lifesaving intervention (for example, in those with hyperkalaemia). For other patients, there may be no clear indicators of when renal replacement therapy should be started because oliguria, fluid overload and uraemia are common and ill-defined indications. An early introduction of renal replacement therapy might reduce the incidence of uraemia or other complications of acute kidney injury, but might also expose the patient to more risks from the therapy itself. Later introduction might increase the incidence of uraemia or other complications of acute kidney injury, but might also reduce the risks associated with renal replacement therapy.
A prospective study is needed of adult inpatients with acute kidney injury AKIN stages 2 and 3, who are likely to need renal replacement therapy within a given timeframe (for example, 72 hours), but have no urgent need for therapy. Units participating in the study should be able to provide early or later dialysis for these patients. Mortality, length of stay, incidence of complications of acute kidney injury, incidence of complications of renal replacement therapy and usage of dialysis should be compared in patients having early therapy and those having later renal replacement therapy. Possible indicators for early renal replacement therapy could be weight gain less than 10%, urea less than 25 mmol/litre and oliguria 0.5 ml/kg/hour or less for at least 24 hours.

Source guidance details

Comes from guidance
Acute kidney injury: prevention, detection and management
Number
CG169
Date issued
August 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 04/09/2013