Does early RRT improve outcomes in AKI?

STARRT-AKI (2020): accelerated strategy showed no mortality difference vs standard (38.8% vs 35.3% at 90 days). Standard strategy had higher dialysis independence. Conservative strategy is now preferred.

When should RRT be initiated immediately?

Absolute indications for immediate RRT: refractory hyperkalemia (K+ >6.5 mmol/L), refractory metabolic acidosis (pH <7.1), symptomatic uremia (encephalopathy, pericarditis), and refractory pulmonary edema.

Which RRT modality is preferred in hemodynamically unstable ICU patients?

CRRT is preferred over IHD in hemodynamically unstable patients. CRRT allows slower fluid removal, better BP stability, and more gradual metabolic correction.

RRT Timing Conservative vs Liberal Evidence

Compare early/liberal vs delayed/conservative RRT initiation strategies in AKI. STARRT-AKI and IDEAL-ICU trials support conservative strategy without mortality benefit of early initiation.

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