Timing of Kidney Replacement Therapy Initiation in Patients With Septic Shock: A Descriptive Study Using a Japanese Inpatient Database

Background Kidney Replacement Therapy (KRT) timing in septic shock remains debated. We assessed temporal trends in KRT initiation and outcomes in Japan. Methods Using a nationwide EMR database (2016–2023), we included adults (≥ 20 years) with septic shock admitted to the intensive care unit (ICU) or high‐dependency care unit (HDU) on day 0 who received KRT. Outcomes were KRT timing by hospital day, in‐hospital mortality, and KRT dependency at discharge; sensitivity analyses used consistently reporting hospitals. Results Among 688 hospitalizations (median age 74 years), KRT initiation shifted later, with day ≥ 2 initiation reaching 38.5% in 2023. In 2022, mortality was 54.3% ( n = 25), and KRT dependency was 43.5% ( n = 20). Patterns were similar across modalities/settings. Conclusions KRT initiation shifted toward later timing after 2022. Studies with granular severity and indication data are needed to clarify drivers of variation and outcomes.