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VOLUME 24 , ISSUE 8 ( August, 2020 ) > List of Articles


Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: Getting the Timing Right

Valentine A Lobo

Citation Information : Lobo VA. Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: Getting the Timing Right. Indian J Crit Care Med 2020; 24 (8):624-625.

DOI: 10.5005/jp-journals-10071-23540

License: CC BY-NC 4.0

Published Online: 14-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Recent trials have failed to show a survival benefit from the early initiation of dialytic therapies in acute kidney injury (AKI), but the problem has not been studied in pregnancy-related AKI. While the KDIGO criteria have not been validated in pregnancy-related acute kidney injury (PRAKI), additionally both fetal and maternal outcomes require to be studied. The short observational study by Banerjee et al. contains some interesting observations.

  1. Mehta RL. Renal-replacement therapy in the critically ill—does timing matter? N Engl J Med 2016;375(2):175–176. DOI: 10.1056/NEJMe1606125.
  2. The STARRT-AKI Investigators, for the Canadian Critical Care Trials Group, The Australian and New Zealand Intensive Care Society Clinical Trials Group, The United Kingdom Critical Care Research Group, the Canadian Nephrology Trials Network, and The Irish Critical Care Trials Group, Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med 2020;383(3):240–251.
  3. Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Frederique schortgen et al for the AKIKI study group initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med 2016;375(2):122–133. DOI: 10.1056/NEJMoa1603017.
  4. Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med 2018;379(15):1431–1442. DOI: 10.1056/NEJMoa1803213.
  5. Jamale TE, Hase NK, Kulkarni M, Pradeep KJ, Keskar V, Jawale S, et al. Earlier-start vs usual-start dialysis in patients with community-acquired acute kidney injury: a randomized controlled trial. Am J Kidney Dis 2103;62(6):1116–1121. DOI: 10.1053/j.ajkd.2013.06.012.
  6. Banerjee A, et al. Comparison of standard conservative treatment and early initiation of renal replacement therapy in pregnancy related acute kidney injury (PRAKI): a single centre prospective study. Ind J Crit Care Med 2020;24(8):688–694.
  7. Macedo E, Mehta RL. When should renal replacement therapy be initiated for acute kidney injury? Semin Dial 2011;24(2):132–137. DOI: 10.1111/j.1525-139X.2011.00838.x.
  8. Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M. Intensive hemodialysis associates with improved pregnancy outcomes: a canadian and United States cohort comparison. J Am Soc Nephrol 2014;25(5):1103–1109. DOI: 10.1681/ASN.2013080825.
  9. Bramham K, Nelson-Piercy C. Pregnancy and renal physiology. In: Turner NN, Lameire N, Goldsmith DJ, Winearls CG, Himmelfarb J, Remuzzi G, ed. Oxford textbook of Clinical Nephrology. 4th ed., 2016. pp. 2190–2198.
  10. Zarbock A, Kellum JA, Schmidt C, Aken HV, Wempe C, Pavenstädt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury the ELAIN randomized clinical trial. JAMA 2016;315(20):2190–2199. DOI: 10.1001/jama.2016.5828.
  11. Gaudry S, Quenot JP, Hertig A, Barbar SD, Hajage D, Ricard JD, et al. Timing of renal replacement therapy for severe acute kidney injury in critically ill patients. Am J Respir Crit Care Med 2019;199(9):1066–1075. DOI: 10.1164/rccm.201810-1906CP.
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