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ST-segment elevation (STE) in the lead aVR indicates global ischemia of the myocardium and is often associated with obstructive coronary artery disease (CAD). We report a serial of cases presenting with STE in aVR and diffuse ST depressions in more than six other leads as a common feature, but of different etiologies, i.e., severe anemia due to gastrointestinal bleeding; drug overdose induced vasospasm and tachycardia, and severe CAD involving distal left main and ostial right coronary arteries, which required specific management approaches. We categorize the possible causes of STE in aVR with or without diffuse ST depression ECG according to whether anticoagulation/antithrombotic agents are indicated, contraindicated, and propose a systematic approach in evaluating and managing these patients.

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Acute kidney injury (AKI) is prevalent in the critically ill with an incidence of greater than 50%. 1 Despite advances, the outcomes of patients requiring acute renal replacement therapy (RRT) are poor, often with 60-and 90-day mortality rates of greater than 50%. 2 Sepsis-associated acute kidney injury (SA-AKI) is distinct from other causes of AKI and is associated with worse outcomes than non-sepsisassociated renal failure. 3,4 While SA-AKI is the leading cause of renal failure in the intensive care unit (ICU), responsible for approximately 20% of AKI, characteristics and outcomes of septic patients requiring acute RRT are not known. The goal of this study was to retrospectively analyze patients with sepsis who required RRT and compare outcomes with patients with sepsis who did not require RRT at

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