Introduction: Background: Severe acute kidney injury (AKI) poses a significant clinical and economic burden, especially in resource-limited settings.The optimal timing for initiating renal replacement therapy (RRT) remains uncertain.Aim: To compare the characteristics and clinical outcomes of patients with severe AKI managed with early RRT versus conservative management at a tertiary hospital in the Philippines.Methods: This single-center retrospective cohort study included 669 adult patients with KDIGO stage 3 AKI from 2021-2025.Patients were categorized into early RRT (initiated within 24 hours of diagnosis) or conservative management (medical treatment with or without delayed RRT).Outcomes included in-hospital mortality, renal recovery, and dialysis dependence.Logistic regression was used to adjust for confounders.Results: Early RRT was initiated in 16% of patients.There were no statistically significant differences in in-hospital mortality (16% vs. 24%; p = 0.063), renal recovery (21% vs. 30%; p = 0.107), or dialysis dependence (29% vs. 30%; p = 0.879) between early and conservative management groups.Conclusion: Early initiation of RRT did not confer significant clinical benefits over conservative management in severe AKI.In resourceconstrained settings, a symptom-guided, individualized approach may help reduce unnecessary RRT without compromising outcomes.I have no potential conflict of interest to disclose.I used generative AI and AI-assisted technologies in the writing process.During the preparation of this work the authors used ChatGPT in order to ask if some sentences can be improved to make some paragraphs more cohesive and concise.After using this tool/service, the authors reviewed and
Mana et al. (Wed,) studied this question.