6/29/23, 11:45 PM STARRT-AKI Pathway Feedback Search Clinical Topics Home Studies STARRT AKI STARRT AKI Disease Acute kidney injury Trial question What is the role of accelerated initiation of RRT in critically ill patients with AKI? Study design Multi-center Open label RCT Population Characteristics of study participants 32.0% female N = 3019 68.0% male 3019 patients (937 female, 1990 male) Inclusion criteria: critically ill patients with severe AKI Key exclusion criteria: potassium > 5.5 mmol/L; bicarbonate < 15 mmol/L; any RRT in preceding 2 months; kidney transplant within the past year; advanced CKD; kidney obstruction, glomerulonephritis, vasculitis, microangiopathy, or acute interstitial nephritis Interventions N=1512 an accelerated strategy (initiation of RRT within 12 hours of meeting full eligibility criteria) N=1507 a standard strategy (initiation of RRT discouraged until development of conventional indications or persistent AKI for 72 hours) Primary outcome https://web.pathway.md/studies/rec1mY5ym53IFoluo 1/2 6/29/23, 11:45 PM STARRT-AKI Pathway Death from any cause at 90 days 43.9 % 43.9 43.7 32.9 % 21.9 % 11.0 % No significant difference 0.0 % An accelerated strategy A standard strategy No significant difference in death from any cause at 90 days (43.9% vs. 43.7%; RR 1, 95% CI 0.93 to 1.09) Secondary outcomes Borderline significant increase in renal replacement dependence among survivors at 90 days (10.4% vs. 6%; RR 1.74, 95% CI 1.24 to 2.43) No significant difference in death or renal replacement dependence at 90 days (50% vs. 47.3%; RR 1.06, 95% CI 0.98 to 1.14) No significant difference in major adverse kidney events (76.7% vs. 77.1%; RR 0.99, 99% CI 0.95 to 1.04) Safety outcomes No significant difference in serious adverse events. Significant differences in any adverse event (23.0% vs. 16.5%), hypotension (8.7% vs. 5.6%), hypophosphatemia (7.5% vs. 4.2%). Conclusion In critically ill patients with severe AKI, an accelerated strategy was not superior to a standard strategy with respect to death from any cause at 90 days. Reference STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group et al. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020 Jul 16;383(3):240-251. Open reference URL https://web.pathway.md/studies/rec1mY5ym53IFoluo 2/2