Clinical Trials

Inclusion Criteria

• Age ≥ 18 years
• Admission to an intensive care unit (ICU)
• Evidence of kidney dysfunction [serum creatinine ≥100 µmol/L (women) and ≥ 130 µmol/L (men)]
• Evidence of severe acute kidney injury defined by at least 1 of 3 criteria
  • ≥ 2-fold increase in serum creatinine from a known pre-morbid baseline or during the current hospitalization
  • 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
  • Urine output < 6.0 mL/kg over the preceding 12 hours

Exclusion Criteria

• Serum potassium > 5.5 mmol/L
• Serum bicarbonate < 15 mmol/L
• Presence of a drug overdose that necessitates initiation of renal replacement therapy
• Lack of commitment to ongoing life support (including RRT)
• Any RRT within the previous 2 months (either acute or chronic RRT)
• Kidney transplant within the past 365 days
• Known pre-hospitalization advanced chronic kidney disease, defined by an estimated glomerular filtration rate < 20 mL/min/1.73 m2
• Presence or clinical suspicion of renal obstruction, rapidly progressive glomerulonephritis, vasculitis, thrombotic microangiopathy or acute interstitial nephritis
• Clinician(s) caring for patient believe(s) that immediate RRT is mandated
• Clinician(s) caring for patient believe(s) that deferral of RRT initiation is mandated
  • at their discretion, clinicians may administer a bolus of intravenous furosemide (ie, "furosemide stress test") and evaluate the subsequent urine output to help guide decision making regarding the likelihood of AKI progression