{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:07:47Z","timestamp":1788174467942,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Critically ill cirrhotics (CIC) pose a management challenge due to severe metabolic and renal impairment. The ideal timing of initiation of dialysis in acute kidney injury (AKI) in CIC is not known. We aimed to compare the safety and efficacy of early (ED) versus late (LD) initiation of sustained low\u2010efficiency dialysis (SLED) in CIC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>CIC were randomized to ED (SLED initiated within 6\u201312\u2009h) or the LD (where SLED was performed when the patient met absolute criteria) group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty CIC (aged 45.2\u2009\u00b1\u200910\u2009years), 90% males, 87% alcohol\u2010related, 72% with pneumonia admitted to liver ICU were randomized to ED or LD group. Baseline lactate (mg\/dL) (2.7\u2009\u00b1\u20091.8 vs. 3.3\u2009\u00b1\u20092.1) and SOFA scores (12.9\u2009\u00b1\u20092.1 vs. 13.7\u2009\u00b1\u20094.0) were comparable. Median time to dialysis (in hours) was 7 (IQR 6\u20138) in ED and 24 (18\u201348) in LD group. Mortality at 28\u2009days (56% vs. 76%; <jats:italic>p<\/jats:italic>\u2009=\u20090.14) was similar. A significantly lower incidence of intradialytic hypotension (IDH) (12% vs. 48%; <jats:italic>p<\/jats:italic>\u2009=\u20090.005), and better urea reduction (75% vs. 41%, <jats:italic>p<\/jats:italic>\u2009=\u20090.019), reversal of shock (60% vs. 16%; <jats:italic>p<\/jats:italic>\u2009=\u20090.001), renal functions (68% vs. 12%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and lower early deaths at Day 7 were noted in the ED (20% vs. 52%; <jats:italic>p<\/jats:italic>\u2009=\u20090.038).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Timely initiation of dialysis could avert the development or progression of metabolic complications, decrease the incidence of IDH and early deaths in CIC. A higher frequency of recovery of renal functions and reduced AKI\u2010related mortality could be achieved by timely dialysis in CICs.<\/jats:p><jats:p><jats:bold>Trial Registration:<\/jats:bold> NCT02937961<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.70216","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T06:36:11Z","timestamp":1758782171000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early Versus Late Dialysis in Cirrhosis Patients and Septic Shock (ELDICS Study): A Randomized Controlled Trial (NCT02937961)"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0110-5982","authenticated-orcid":false,"given":"Rakhi","family":"Maiwall","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samba Siva Rao","family":"Pasupuleti","sequence":"additional","affiliation":[{"name":"Department of Statistics, Mizoram University (A Central University) Pachhunga University, College Campus  Aizawl India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Critical Care Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherin","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Biochemistry Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh Vardhan","family":"Tevethia","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendra Prasad","family":"Mathur","sequence":"additional","affiliation":[{"name":"Department of Nephrology Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiv Kumar","family":"Sarin","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14809"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000067"},{"issue":"3","key":"e_1_2_12_4_1","article-title":"Acute\u2010On\u2010Chronic Liver Failure: Definitions, Pathophysiology and Principles of Treatment","volume":"2","author":"Zaccherini G.","year":"2020","journal-title":"JHEP Reports"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15279"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003701"},{"issue":"16","key":"e_1_2_12_7_1","first-page":"240","article-title":"Timing of Initiation of Renal\u2010Replacement Therapy in Acute Kidney Injury","volume":"383","author":"STARRT\u2010AKI Investigators; Canadian Critical Care Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group; United Kingdom Critical Care Research Group; Canadian Nephrology Trials Network; Irish Critical Care Trials Group","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.5828"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30531-6"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000102122"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2017.05.002"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201706-1255OC"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.11.003"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000028118"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2017060694"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000503776"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12630"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2010.00769.x"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfk069"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI42004"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M111.275719"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00195.2018"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18102200"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-018-0015-5"}],"container-title":["JGH Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgh3.70216","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T08:56:07Z","timestamp":1760691367000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgh3.70216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":23,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/jgh3.70216"],"URL":"https:\/\/doi.org\/10.1002\/jgh3.70216","archive":["Portico"],"relation":{},"ISSN":["2397-9070","2397-9070"],"issn-type":[{"value":"2397-9070","type":"print"},{"value":"2397-9070","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2024-08-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70216"}}