Chapter 20 Acute dialysis

20.1 Dose

Ronco et al. (2000): - 20 vs. 35 vs. 45 ml/kg/hr prescribed UF rates for CVVH in AKI. Short-term survival was higher at UF \(\geq\) 35 ml/kg/hr (with no further benefit at 45).

VA/NIH ARFTN (2008): - intensive vs. standard RRT in AKI. Intensive = 35 ml/kg/hr effluent flow (pre-dilution CVVHDF) or HD / SLED 6x per week (each spKt/V 1.2–1.4); standard = 20 ml/kg/hr or HD / SLED 3x per week. No effect on 60-day survival or renal recovery.

RENAL (2009): - post-dilution CVVHDF 25 vs. 40 ml/kg/hr: no effect on 90-day mortality.

20.2 Timing

The bulk of the literature does not support early initiation of RRT in AKI.

AKIKI(2016): - early vs. delayed initiation of RRT in AKI (n = 620). No effect on 60-day mortality; more line sepsis and later diuresis in early initiation group.

IDEAL-ICU: - early vs. delayed initiation of RRT in AKI in sepsis (n = 488). No effect on 90-day mortality (which was over 50% in both groups).

STARRT-AKI: - early vs standard RRT in AKI (n = 3000). No benefit on primary outcome of death at 90 days. More adverse events and more ongoing requirement for RRT in early group.

Gaudry et al.: - individual patient-level meta-analysis confirms no benefit of early initiation.