These issues deserve future prospective evaluations.ConclusionsTogether with those of Elseviers et al. [22], our findings raise concern about the actual efficacy of RRT. Of course, these results must be cautiously interpreted since the selleck chemicals 17-AAG assessment of RRT efficacy through observational data is very challenging. However, they emphasize the need for a critical reappraisal of current RRT practices. Large randomized controlled trials comparing RRT to conservative management in selected ICU patients with AKI, and focusing on RRT timing, are urgently warranted to provide definite conclusions.Key messages? Aside from life-threatening conditions, evidence supporting the use of renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) is lacking.

Currently available data on RRT efficacy exclusively stem from observational studies, whose results may have been confounded by treatment selection bias and differences in patients’ severity.? In this study, we extensively dealt with confounding by using the propensity score technique and multivariate regression models to provide an as accurate as possible estimation of RRT efficacy.? RRT was not associated with decreased mortality and even seemed to impair patients’ outcome when initiated too late.? These results emphasize the need for further randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.

AbbreviationsAKI: acute kidney injury; APACHE: Acute Physiology and Chronic Health Evaluation; CKD: chronic kidney disease; CI: confidence interval; GFR: glomerular filtration rate; ICU: intensive care unit; MDRD: Modification of Diet in Renal Disease; OR: odds ratio; RIFLE: Risk: Injury: Failure: Loss and End-stage renal failure; RRT: renal replacement therapy; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsCC designed the study and wrote the manuscript; CC and JFT performed the statistical analyses; MD, AL, FC, EA, CS, ASD, MGO, DGT, and YC participated in the collection of data and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.Supplementary MaterialAdditional file 1:Baseline characteristics of RIFLE R class patients with and without renal replacement therapy (RRT).Click here for file(40K, DOC)Additional file 2:Baseline characteristics of RIFLE I class patients with and without renal replacement therapy (RRT).Click here for file(40K, DOC)Additional file 3:Baseline characteristics of RIFLE F class patients with and without renal Entinostat replacement therapy (RRT).