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Acute kidney injury can be accompanied by life-threatening electrolyte and metabolic abnormalities. Kidney-replacement therapy may be urgently needed to prevent death from uremia. This review considers treatment approaches, indications, and intensity in critically ill patients with AKI.

[...]emerging data, suggest that an overly aggressive approach to fluid removal in the early phase of AKI might actually worsen outcomes [4]. The primary endpoint, catheter-free days at day 28, relies on a clinician-driven decision and, while it captures a relevant process of care, it remains a surrogate outcome that does not directly measure total RRT duration, renal recovery, or any patient-centered benefit. Since the authors explicitly aim to define objective criteria for RRT discontinuation, one would have expected a primary outcome more directly linked to renal function or clinical recovery, rather than an indirect and operator-dependent measure. [...]in a before–after design, one cannot exclude that the observed differences stemmed in part from increased awareness and procedural vigilance regarding catheter removal in the second period, a form of behavioral shift that commonly arises when a protocol is introduced on a topic perceived as a “hot issue” by the clinical team. Because UO is both a component of UUEI and the main comparator, this mathematical overlap artificially boosts the correlation between the two, making the index seem more predictive than it may actually be.

Patients might also experience better sleep quality, as RRT machines and alarms are a frequent source of disturbances improving the overall ICU environment. [...]RRT is a resource-intensive procedure, and minimizing its use would reduce both costs and the carbon footprint of critical care, in an era of increasing attention to healthcare sustainability [6]. STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, United Kingdom Critical Care Research Group, Canadian Nephrology Trials Network, Irish Critical Care Trials Group, et al. Renal replacement therapy intensity for acute kidney injury and recovery to dialysis independence: a systematic review and individual patient data meta-analysis.

This multicenter randomized trial compared strategies of early and delayed renal-replacement therapy in patients with severe acute kidney injury. There was no significant difference in mortality, the primary outcome, between the study groups. Acute kidney injury is a common condition among patients in the intensive care unit 1 – 4 and is associated with high morbidity and mortality. 2 , 5 – 8 Renal-replacement therapy is the cornerstone of the management of severe acute kidney injury. Many studies have focused on methods of renal-replacement therapy, 5 , 6 , 8 , 9 but the issue of when to initiate the therapy in the absence of a potentially life-threatening complication directly related to renal failure remains a subject of debate. Indirect evidence has suggested that early renal-replacement therapy could confer a survival benefit. 10 – 12 However, two observational studies reported high survival rates among . . .

To the Editor: We agree with the statement by Gaudry et al. in their review article (March 10 issue) 1 that in poisonings caused by dialyzable substances, rapid removal of the toxicants is life-saving. This is true even in the absence of acute kidney injury, although acute kidney injury is an independent factor associated with an increased risk of death in poisonings. 2 Management of poisonings caused by substances other than the cited salicylate, lithium, metformin, and toxic alcohol can also be facilitated with the use of extracorporeal kidney-replacement therapy, albeit with uncertain clinical benefit. 3 However, the indications, timing, duration, and specific . . .