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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Early vs late start of dialysis: it’s all about timing. | Macedo and Mehta Critical Care 2010 14 112 http ccforum.eom content 14 1 112 CRITICAL CARE COMMENTARY L__ Early vs late start of dialysis it s all about timing Etienne Macedo and Ravindra L Mehta See related research by Shiao etal. http ccforum.eom content 13 5 R171 Abstract Acute kidney injury AKI is now well recognized as an independent risk factor for increased morbidity and mortality particularly when dialysis is needed. The wide variation in dialysis utilization contributes to a lack of consensus on what parameters should guide the decision to start dialysis. While the association of early initiation of dialysis with survival benefit was first demonstrated four decades ago few studies in the modern era of dialysis have addressed time of dialysis initiation. Though listed as one of the top priorities in research on AKI timing of dialysis initiation has not been included as a factor in any of the large randomized controlled trials in this area. Whether or not to provide dialytic support and when to start are two dilemmas for clinicians managing patients with a sudden decline in renal function. Earlier initiation is thought to be associated with better control of uremia acidemia electrolyte imbalances and volume accumulation. However the appreciation of the effect of time of initiation depends on what is considered early versus late. Various studies have considered early versus late time of dialysis initiation based on arbitrary thresholds of traditional serum biomarkers or time from intensive care unit ICU admission or from the diagnosis of acute kidney injury AKI . The study by Shiao and colleagues 1 in a recent issue of Critical Care provides support that early start may be beneficial and offers an additional approach to identifying a starting point for dialysis. Although a recent meta-analysis that included four randomized controlled trials and 19 observational studies conducted over four decades suggested that early dialysis initiation may have a .
