STARRT-AKI
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
68.0% male
N = 2927
2927 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=1465 an accelerated strategy (initiation of RRT within 12 hours of meeting full eligibility criteria).
N=1462 a standard strategy (initiation of RRT discouraged until development of conventional indications or persistent AKI for ≥ 72 hours).
Primary outcome
Death from any cause at 90 days
43.9%
43.7%
43.9 %
32.9 %
21.9 %
11.0 %
0.0 %
An accelerated
strategy
A standard
strategy
No significant
difference ↔
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
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.
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