Timing of Initiation of Kidney Replacement Therapy in Acute Kidney Injury in the Critically Ill Patient

Abstract

Acute kidney injury (AKI) represents one of the most frequent complications in critically ill patients. In recent years, mortality rates have exceeded 50%, and 10% of them require kidney replacement therapy (KRT). Since the 60’s, the question of when to start KRT has been raised, classically the time of temporality when life-threatening is present (hyperkalemia, metabolic acidosis, uremia, and fluid overload); Therefore, in the last decade, the possibility of early initiation was raised as a strategy to achieve better outcomes. Current evidence shows that the timing of late onset dialysis has the same results as the strategy of early begining. We will also review the considerations in relation to renal capacity and demand generated by the acute pathology in a critically ill patient and the set of variables to make better decisions.