• Tukaram E Jamale, Niwrutti K Hase, Manjunath Kulkarni, K J Pradeep, Vaibhav Keskar, Sunil Jawale, and Dinesh Mahajan.
• Seth GS Medical College and KEM Hospital, Mumbai. Electronic address: tukaramjamale@yahoo.co.in.
• Am. J. Kidney Dis. 2013 Dec 1;62(6):1116-21.

BackgroundOptimum timing of the initiation of dialysis therapy in acute kidney injury is not clear.Study DesignProspective, open label, 2-arm, randomized, controlled trial.Setting & Participants208 adults with acute kidney injury with progressively worsening azotemia at the artificial kidney dialysis unit of a tertiary-care referral center in western India.InterventionEarlier-start dialysis was initiated when serum urea nitrogen and/or creatinine levels increased to 70 and 7 mg/dL, respectively, whereas the usual-start dialysis patients (control group) received dialysis when clinically indicated as judged by treating nephrologists.OutcomesPrimary outcome was in-hospital mortality and dialysis dependence at 3 months. Secondary outcome in patients receiving dialysis was time to recovery of kidney function, computed from time of enrollment to the last dialysis session.ResultsOf 585 screened patients, 102 were assigned to earlier-start dialysis, and 106 to usual-start dialysis. Baseline characteristics were similar between randomized groups. 93 (91.1%) and 88 (83.1%) participants received dialysis in the intervention and control groups, respectively. Mean serum urea nitrogen and serum creatinine levels at dialysis therapy initiation were 71.7 ± 21.7 (SD) and 7.4 ± 5.3 mg/dL, respectively, in the intervention group versus 100.9 ± 32.6 and 10.41 ± 3.3 mg/dL in the control group. Data on primary outcome were available for all patients. In-hospital mortality was 20.5% and 12.2% in the intervention and control groups, respectively (relative risk, 1.67; 95% CI, 0.88-3.17; P = 0.2). 4.9% and 4.7% of patients in the intervention and control groups, respectively, were dialysis dependent at 3 months (relative risk, 1.04; 95% CI, 0.29-3.7; P = 0.9).LimitationsStudy was not double blind, event rate (ie, mortality) was less than predicted, wide CIs preclude definitive findings.ConclusionsOur data do not support the earlier initiation of dialysis therapy in community-acquired acute kidney injury.Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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