Only the A-E-I-O-U’s to start RRT and now we know “Y”! The Start-AKI Trial

In residency and med school we are always taught the indications for emergent CRRT as the mnemonic: AEIOU

metabolic acidosis with a pH < 7.1 Electrolytes hyperkalemia > 6.5 mEq/L refractory to treatment or rapidly rising levels in potassium
with dialyzable drug, including salicylates, lithium, isopropanol, methanol, and ethylene glycol (SLIME)
volume overload that does not respond to diuresis
especially with increased oxygen requirements
causing: uremic bleeding, encephalopathy, pericarditis, and neuropathy

However, in the ICU there has always been a question of how early should we start RRT in the setting of oliguria and BUN not causing symptoms. Initial thoughts were that earlier is better. Today’s infographic focuses on the latest RCT to determine the timing of CRRT. The Bottom Line here is that for the START-AKI TRIAL: Unless there is the emergent a-e-i-o-u’s to start CRRT doing it early does not appear to translate to a mortality benefit. There may be a signal of dialysis dependence at 90 days in this trial. Now we know “Y” we should wait until we have an indication other than the AEIOU’s.

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