Department of Critical Care

Eligibility and Criteria

Inclusion Criteria:

  1. Age ≥ 18 years;
  2. Admission to an intensive care unit (ICU);
  3. Evidence of kidney dysfunction [serum creatinine ≥100 µmol/L (women) and ≥ 130 µmol/L (men)] and;
  4. Evidence of severe AKI defined by at least 1 of the following 3 criteria:
    1. ≥ 2-fold increase in serum creatinine from a known pre-morbid baseline or during the current hospitalization; OR
    2. Achievement of a serum creatinine ≥ 354 µmol/L with evidence of a minimum increase of 27 µmol/L from pre-morbid baseline or during the current hospitalization; OR
    3. Urine output < 6.0 ml/kg over the preceding 12 hours

Exclusion Criteria:

  1. Serum potassium > 5.5 mmol/L;
  2. Serum bicarbonate < 15 mmol/L;
  3. Presence of a drug overdose that necessitates initiation of RRT;
  4. Lack of commitment to ongoing life support (including RRT);
  5. Any RRT within the previous 2 months (either acute or chronic RRT);
  6. Kidney transplant within the past 365 days;
  7. Known pre-hospitalization advanced chronic kidney disease, defined by an estimated glomerular filtration rate < 20 ml/min/1.73m2;
  8. Presence or clinical suspicion of renal obstruction, rapidly progressive glomerulonephritis, vasculitis, thrombotic microangiopathy or acute interstitial nephritis;
  9. Clinician(s) caring for patient believe(s) that immediate RRT is absolutely mandated;
  10. Clinician(s) caring for patient believe(s) that deferral of RRT initiation is mandated.