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The first report of RRT in AKI was published in 1965.766 Despite more than six decades of clinical experience and research, controversy remains about the best way to measure and what constitutes optimal dose of RRT for patients with AKI. Indeed, three of the top five questions considered most relevant by an international expert’s panel on RRT delivery in AKI were about dose.767
The methods used for RRT dose quantification in AKI have several limitations, and have not been fully validated in this specific population. Earlier single-center trials assessing the effects of RRT dose in AKI provided conflicting results.531,768–772 Considering the complexity of AKI patients, RRT dose, by itself, may have less impact on mortality both in patients with very high or very low chance of surviving, but may be most important in patients with intermediate scores of disease severity.773 In addition, it is possible that dose and timing are closely linked factors, i.e., a high RRT dose may not work adequately if provided late, or an early RRT starting may not be able to change outcomes if the dose is not optimized. Currently, only one small RCT considered both variables at the same time.531
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