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Highly Accessed Open Badges Commentary

Renal replacement therapy: to treat, or not to treat, that is the question...

Michael Joannidis1* and Lui G Forni2

Author Affiliations

1 Medical Intensive Care and Emergency Unit, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria

2 Department of Critical Care, Western Sussex Hospitals Trust, Honorary Senior Lecturer, Brighton and Sussex Medical Schools, University of Sussex, Falmer, Brighton BN1 9PX, UK

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Critical Care 2013, 17:125  doi:10.1186/cc12535

See related research by Clec'h et al., and related research by Thakar et al.,

Published: 19 March 2013


When to commence renal replacement therapy (RRT) in the critically ill remains an unresolved issue. The study by Thakar and colleagues sheds some light on current practice through an international survey, demonstrating physicians' inclination to start RRT earlier when the severity of disease is higher. However, Clec'h and co-workers investigated the effect of RRT on hospital survival by performing a propensity analysis on the large multicentre French OUTCOMEREA database. They demonstrate that RRT does not confer survival benefit, with a delay in initiation being proposed as a contributing factor.