The Artificial Kidney Initiation in Kidney Injury (AKIKI) trial and the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial, 2 randomized clinical trials conducted in the intensive care unit (ICU), showed no difference in mortality between an early or delayed strategy of initiation of RRT.

However, these studies mainly included patients with sepsis. The Early versus deLAyed Initiation (ELAIN) of RRT in critically ill patients with AKI study, which mostly included postoperative cardiac surgery patients in its population, showed a decrease in mortality for early initiation of RRT.

We note that STARRT-AKI and AKIKI found a decrease in RRT rate of 35% and 51%, respectively, in the delayed strategy group. On the contrary, there was no such decrease in ELAIN, with a 92% RRT rate in this group. In our cardiothoracic ICU, the physicians’ practice is to start RRT late.