The optimal timing of kidney support therapy in critically ill patients with acute kidney injury (AKI) without life-threatening complications related to AKI is controversial. Recent multicenter, randomized, controlled studies have questioned the need for earlier initiation of therapy, despite one study showing a benefit in survival and others with no differences in mortality based on the timing of kidney support therapy initiation. These findings reflect the uncertainties in decisions to initiate kidney support therapy, which should ideally be individualized according to the patient’s comorbidities, severity of illness, trajectory of kidney function, and urine output as well as requirements for fluid balance and solute removal. A delayed approach could translate into a potentially reduced burden of dialysis dependence in addition to saving health resources. However, we must ascertain what constitutes the waiting period and the benefits and risks associated with this approach. This article reviews the concept of timing of dialysis in AKI, performs a critical assessment of the most important clinical trials in this topic, discusses ongoing research and knowledge gaps, and defines key research issues to address in the future.

中文翻译：

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急性肾损伤中肾脏支持治疗的时机：我们还在等什么？


对于没有与 AKI 相关的危及生命并发症的急性肾损伤 (AKI) 危重患者，肾脏支持治疗的最佳时机存在争议。最近的多中心、随机、对照研究对早期开始治疗的必要性提出了质疑，尽管一项研究显示根据肾脏支持治疗开始的时间对生存有好处，而其他研究显示死亡率没有差异。这些发现反映了启动肾脏支持治疗决策的不确定性，理想情况下应根据患者的合并症、疾病严重程度、肾功能轨迹、尿量以及液体平衡和溶质清除的要求进行个体化治疗。除了节省卫生资源之外，延迟的方法还可能减少透析依赖的负担。然而，我们必须确定等待期的构成以及与这种方法相关的好处和风险。本文回顾了 AKI 中透析时机的概念，对该主题中最重要的临床试验进行了严格评估，讨论了正在进行的研究和知识差距，并定义了未来要解决的关键研究问题。