• Sean M Bagshaw, Shigehiko Uchino, Rinaldo Bellomo, Hiroshi Morimatsu, Stanislao Morgera, Miet Schetz, Ian Tan, Catherine Bouman, Ettiene Macedo, Noel Gibney, Ashita Tolwani, Heleen M Oudemans-van Straaten, Claudio Ronco, John A Kellum, and Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators.
• Department of Intensive Care and Department of Medicine, Austin and Repatriation Medical Centre, Melbourne, Australia. bagshaw@ualberta.ca
• J Crit Care. 2009 Mar 1;24(1):129-40.

PurposeThe aim of this study is to evaluate the relationship between timing of renal replacement therapy (RRT) in severe acute kidney injury and clinical outcomes.MethodsThis was a prospective multicenter observational study conducted at 54 intensive care units (ICUs) in 23 countries enrolling 1238 patients.ResultsTiming of RRT was stratified into "early" and "late" by median urea and creatinine at the time RRT was started. Timing was also categorized temporally from ICU admission into early (<2 days), delayed (2-5 days), and late (>5 days). Renal replacement therapy timing by serum urea showed no significant difference in crude (63.4% for urea 24.2 mmol/L; odds ratio [OR], 0.92; 95% confidence interval [CI], 0.73-1.15; P = .48) or covariate-adjusted mortality (OR, 1.25; 95% CI, 0.91-1.70; P = .16). When stratified by creatinine, late RRT was associated with lower crude (53.4% for creatinine >309 micromol/L vs 71.4% for creatinine ConclusionTiming of RRT, a potentially modifiable factor, might exert an important influence on patient survival. However, this largely depended on its definition. Late RRT (days from admission) was associated with a longer duration of RRT, longer hospital stay, and higher dialysis dependence.

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