Summary : RRT is indicated for the acute management of life-threateningcomplications of AKI. These include volume overload unresponsive todiuretics, uremic symptoms and signs (eg, encephalopathy and serositis),severe metabolic acidosis, overdose with a dialyzable drug/toxin, andhyperkalemia. Whether there is a benefit to early initiation of RRT forvolume management rather than escalating diuretic dose is not known.The optimal timing for initiation of RRT in patients with AKI will requirean adequately powered prospective randomized trial. Adequate design ofsuch a trial is limited by the current inability to quickly prospectivelyidentify patients with early AKI who will have protracted renal injury andeventually require RRT. For this reason, it is not possible to provideevidence-based criteria for the initiation of RRT in AKI. Similarly, althoughseverity of volume overload at the time of initiation of RRT is associatedwith increasing mortality risk, current data do not demonstrate that initiatingRRT at a specific threshold of fluid overload is associated with improvedoutcomes.