The overwhelming data from recent trials do not support a preemptive strategy for KRT initiation in critically ill patients with AKI. In the absence of absolute indications for commencing KRT, clinicians should defer KRT initiation even in the setting of severe AKI. Serial review of the patient that synthesizes new and accumulating AKI-related threats, the trajectory of the patient's illness and the probability of kidney recovery should guide KRT initiation. Ongoing and future research will hopefully address areas of persistent uncertainty, including the safety of prolonged KRT deferral and optimal thresholds for fluid accumulation that should trigger KRT initiation.
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Curr Opin Nephrol Hypertens. 2021;30(3):332-338. © 2021 Lippincott Williams & Wilkins