الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute kidney injury (AKI) is one of the life-threatening situations that is frequently encountered in critically ill patients. The spectrum of AKI varies widely, encompassing subtle changes in biochemical markers of kidney function to severe kidney failure necessitating the initiation of renal replacement therapy (RRT) to treat hazardous consequences such as: severe metabolic acidosis, serious electrolyte disturbance as hyperkalemia or pulmonary edema as a consequence of hypervolemia. Survival benefit of early initiation of RRT is still not proven.
There is still a persistent controversy regarding the optimum time for starting RRT for those who develop serious complications of AKI. Theoretically speaking, early RRT would better correct metabolic derangements although it may be associated with secondary complications such as: arrhythmia, hypotension, coagulopathy or infection. However, cautious postponement of RRT may give a chance for improvement of renal function and metabolic abnormalities without the risk of hemodialysis complications. The results of prior observational and randomized controlled studies on timing of RRT initiation were controversial and inconclusive. That might be attributed to the choice of patients. Therefore more studies are still needed to confirm, disprove or find a significant relationship between the timing of RRT and improvement of morbidity or mortality.