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In Reply Drs Vinsonneau and Monchi and Dr Wang and colleagues point out that the study designs of the ELAIN and AKIKI1 trials differ. For example, patients in the ELAIN trial were treated earlier and were more severely ill compared with patients in the AKIKI trial. We believe that the pivotal difference between ELAIN and AKIKI is the time at which RRT was initiated. This is important because AKI can result in systemic disease affecting inflammation and function of different organs. Early treatment may attenuate the levels of pro-inflammatory mediators and subsequently reduce organ dysfunction.
Zarbock A, Kellum JA. Timing of Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury—Reply. JAMA. 2016;316(11):1214. doi:10.1001/jama.2016.11338