LoW Dose-Intensity vs. Standard Dose-Intensity COntinuous Renal ReplaceMent Therapy in Critically Ill Patients (WISDOM)

An estimated 10-15% of critically ill patients with acute kidney failure in the intensive care unit receive acute dialysis therapy. The majority of these patients initially receive a continuous form of dialysis therapy call continuous renal replacement therapy (CRRT). Prior studies have suggested that higher CRRT dose-intensity improved health outcomes for these patients; however, this was not found in high-quality clinical trials. These more recent trials suggested a lower range of dose-intensity compared with the higher range as the new standard of care. This was incorporated into guidelines. To date, no clinical trials have evaluated this lower range and specifically, it is plausible that an even lower dose-intensity of CRRT may be well tolerated, safe, associated with similar outcomes and be more cost-effective. This is the objective of the WISDOM trial, to compare the guideline standard with lower dose-intensity among patients who are started on CRRT in the intensive care unit.

Inclusion Criteria: * age ≥ 18 years * weight ≥ 55 kg * plan to initiate CRRT or within 24 hours of having started CRRT for AKI * expected to survive and receive CRRT for a duration of ≥ 48 hours * able to provide informed consent or have an authorized representative provide consent after being informed on the details and risks of the trial unless a deferred consent process is approved by local Research Ethics Board (REB). Exclusion Criteria: * indication for sustained higher dose-intensity CRRT as designated by the attending clinicians * end-stage kidney disease receiving maintenance dialysis * receipt of any RRT for AKI during the current hospitalization * inability to comply with the requirements of the study protocol.