Acute Kidney Injury in the Emergency Department: Key Predictors for Early Renal Replacement Therapy

Background: Acute kidney injury (AKI) is a common condition in emergency departments (EDs), often associated with significant mortality and morbidity. This study aimed to identify predictors of renal replacement therapy (RRT) requirement in patients presenting with AKI who did not meet absolute indications for RRT at ED evaluation but subsequently required RRT during follow-up. Methods: A total of 266 patients with AKI who were assessed in the ED were enrolled in this prospective observational study and subsequently monitored in the Internal Medicine Intensive Care Unit (ICU) between October 2022 and September 2023. Patients were allocated into 2 analytically defined categories: those not requiring renal replacement therapy [RRT (−)] and those who required RRT [RRT (+)]. Laboratory and clinical data were recorded prospectively. Results: During follow-up, 30.8% of the patients (n = 82) required RRT due to complications. The overall mortality rate of the study cohort was 32.3%. Regression analysis identified nonsteroidal anti-inflammatory drug (NSAID) use (OR: 7.944, 95% CI: 1.583-39.871, P = .012) and elevated creatinine levels (OR: 1.321, 95% CI: 1.017-1.715, P = .037) as independent predictors of RRT requirement. Receiver operating characteristic analysis revealed that the area under the curve for creatinine levels was 0.818 (95% CI: 0.761-0.874, P < .001). A creatinine cut-off value of 3.15 mg/dL was determined, with a sensitivity of 79.3% and a specificity of 70.1%. Conclusion: NSAID use and elevated serum creatinine at ED presentation are independent predictors of early RRT requirement in AKI patients. These factors may assist clinicians in identifying high-risk patients who may benefit from closer monitoring or earlier intervention. Cite this article as: Akdoğanlar Aİ, Satar S, Acehan S, et al. Acute kidney injury in the emergency department: key predictors for early renal replacement therapy. Eurasian J Med. 2026, 58(2), 1272, doi: 10.5152/eurasianjmed.2026.251272.