Early versus late dialysis?

Idea#65

Stage: Active

Campaign: AKI

For patients with AKI, should dialysis be started early versus late? How should early and late be defined - based on novel biomarkers, volume status, or "conventional" parameters (eg, BUN/Cr)?

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  1. Comment
    Paul Kimmel
    ( Moderator )

    What do you mean by "conventional parameters?"

  2. Comment
    William Fissell

    Seems to me this could be exapnded? Now that we have a strong sense of a few things:

    1- ARF predisposes to subsequent CKD and probably results in permanently changed renal architecture

    2- ARF is a highly complex event that involves all "compartments" of the kidney

    3- Efforts to improve outcomes by adjusting delivered dose and mode of therapy have proved frustratingly limited in visible impact on survival and recovery

    perhaps we need to broaden this a little to ask two questions:

    'what constitutes adequate supportive care after suport becomes necessary'

    and, separately ask,

    'what can be done to abort the chain of events in ARF before support is necessary'.

    The former is sort of a superset of Kathleens excellent suggestion, and the latter closely tied to Paul Palevsky's suggestions regarding biomarkers.

    How could we distill the broad brush strokes I painted with those two questions into defined research programs?

  3. Comment
    Harold Feldman
    ( Moderator )

    To address this question, we will need to address the difficult challenge of identifying the time of onset of AKI to avoid bias from only studying patients who ultimately undergo renal replacement therapy.

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