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Standard versus accelerated initiation of renal replacement therapy in acute kidney injury


To determine whether, in critically ill patients with severe acute kidney injury (AKI), randomization to accelerated initiation of replacement therapy (RRT) compared to a conservative strategy consistent with standard care, leads to improved survival at 90 days.


More than 1 in 2 critically ill patients in the Intensive Care Unit develop acute kidney injury (AKI). A proportion of patients need dialysis treatment, also known as replacement therapy (RRT). The aim of RRT is to remove toxins and excess fluid which may have accumulated because of kidney failure. RRT can be life-saving but has side effects. It requires the insertion of a catheter into a large vein in the neck or groin. This can be complicated by bleeding and blood stream infections. In addition, RRT is expensive. At present, it is not clear whether it is best to start RRT only when patients have evidence of severe AKI or whether it is better to initiate RRT earlier, i.e. as soon as patients have signs of impaired kidney function. This study aims to answer this question. Patients in the ICU with early AKI will be randomised to RRT using standard criteria versus accelerated (earlier) RRT. The aim is to find out whether either strategy improves the chances of survival and/or recovery of kidney function. Data is collected according to baseline characteristics (age, gender, reason for ICU admission), timing of RRT, hospital outcome, and survival status, health status and degree of kidney function at 90 days and 1 year. The results of this study will inform clinicians about the optimal time when to commence RRT so that patients receive RRT when they benefit most. The study will also inform clinicians when RRT can be safely withheld without harming the patient.

Chief/Principal investigator

Chief investigator

Chief investigator

Dr Marlies Ostermann

Principal investigator

Principal investigator

Current recruitment number