Renal replacement therapy (RRT) is used for severe acute kidney injury (AKI). We published the first large trial on RRT timing (AKIKI). It showed no difference in mortality between 2 initiation strategies (early vs delayed) but the delayed one (allowing some patients to escape RRT) was associated with faster renal recovery. RRT might constitute a second hit, which would impair renal recovery by: 1/modifying renal hemodynamic; 2/activating platelets and neutrophils through contact with dialysis membrane; 3/removing plasma molecules involved in tubules regeneration (e.g. vit B3). To test these hypotheses, we set up a rat model of RRT after AKI. Kidney histology and function, tubular damage, hemodynamic, platelets/neutrophils activation/aggregation and NAD+ metabolites will be assessed. It will then be tested in blood/urine samples from patients included in AKIKI2 trial. We will also assess if plasma concentration of NAD+ metabolites is correlated with the time between AKI and recovery.
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