Comparison between Watchful Waiting Strategy and Early Initiation of Renal Replacement Therapy in The Critically Ill Acute Kidney Injury

Abstract

Background: The timing of "renal replacement therapy" (RRT) in patients with "acute kidney injury" (AKI) has been greatly debated  among nephrologists. Some prefer the initial regimen; rapidly correct metabolic disturbances and fluid overload, while others prefer the  delayed approach to avoid possible RRT complications

Objective: To compare the outcomes of early versus delayed RRT in intensive care  unit (ICU) patients diagnosed with stage 3 AKI.

Patients and methods: In this prospective study, 104 ICU patients with stage 3 AKI  diagnoses were enrolled and then  randomly assigned to two groups; Group A included patients who received RRT within 24 hours of AKI  diagnosis, and Group B included other patients who had RRT after 24 hours.

Results: Sepsis/septic shock was the most common etiology  of AKI in both groups. Other causes included major surgery, hypovolemic/hemorrhagic shock, and cardiogenic shock. The two groups  showed comparable needs for vasopressor support and mechanical ventilation. Nonetheless, the duration of RRT, mechanical ventilation,  ICU stay, and hospitalization decreased significantly in the early group. In-hospital mortality increased significantly with the delayed approach (65.38% vs. 42.3% in the early group) (p = 0.034). Discharge creatinine in the survived cases was lower in the early  group (2.01 vs. 2.77 in delayed cases – p < 0.001).

Conclusion: Early RRT is associated with better outcomes compared to the delayed one  in patients with stage 3 AKI. Therefore, early RRT is recommended in such cases to improve patient outcomes.