# Kidney Replacement in AKI: Timing and Modality

Some patients recover without accelerated initiation when urgent indications are absent. Reevaluate both the need to start and readiness to stop using clinical trends.

![Infographic: Kidney Replacement in AKI: Timing and Modality](https://urinenephrology.org/visual-reference/images/mastery-aki-krt.png?v=20261003c)

## Replace a function

Kidney replacement supports solute, electrolyte, acid–base, and volume control while the cause of AKI is treated. It is not a cure for the underlying injury.

## Recognize urgent indications

Refractory electrolyte abnormalities, severe acidemia, pulmonary edema, and selected uremic or toxic complications can require immediate therapy.

## Assess demand versus capacity

Evaluate ongoing fluid and solute generation, residual kidney function, hemodynamics, neurologic concerns, and the trajectory rather than creatinine alone.

## Select the modality

Intermittent, prolonged intermittent, and continuous approaches differ in rate and continuity of correction. Choose with the patient's stability, local expertise, and goals.

## Review harms and delivery

Vascular access, anticoagulation, infection, hypotension, drug clearance, and treatment interruptions matter. Delivered therapy can differ substantially from the prescription.

## Reassess daily

Some patients recover without accelerated initiation when urgent indications are absent. Reevaluate both the need to start and readiness to stop using clinical trends.

## Source lessons

- [krt timing modality aki review](https://urinenephrology.org/mastery/aki-advanced/krt-timing-modality-aki-review.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.