On Demand Versus Protocol-guided Renal Replacement Therapy for Management of Stage 3 Acute Kidney Injury in Patients With Cirrhosis

Exclusion Criteria

• •Patients with age less than 18 years
• •Severe known cardiopulmonary disease (structural or valvular heart disease, coronary artery disease, COPD Chronic Obstructive Pulmonary Disease)
• •Pregnancy
• •Chronic kidney disease on hemodialysis
• •Patients with post renal obstructive AKI (Acute Kidney Injury), AKI (Acute Kidney Injury) suspected due to glomerulonephritis, interstitial nephritis or vasculitis based on clinical history and urine analysis
• •Patients already meeting emergency criteria for immediate hemodialysis at the time of randomization (serum potassium\>6 meq/lt, metabolic acidosis ph\<7.12, acute pulmonary edema, severe volume overload with hypoxemia non-responsive to diuretic treatment)
• •Patients transferred from other hospitals who have already been on hemodialysis before their arrival in the intensive care unit
• •Extremely moribund patients with an expected life expectancy of less than 24 hours
• •Failure to give informed consent from family members.
• •Hemodynamic instability requiring very high dose of vasopressors.