Trial reportLancet (London, England)2021
Comparison of two delayed strategies for renal replacement therapy initiation for severe acute kidney injury (AKIKI 2): a multicentre, open-label, randomised, controlled trial.
Trial report in Lancet (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 141 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Artificial Kidney Initiation in Kidney Injury 2 A Multi-Centre, Randomized, Controlled Trial
Effect of a Furosemide Stress Test-Guided Strategy on Liberation From Continuous Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury (FST-LIBERATE)
Who cites it
141 citing papers in PubMed, 11 syntheses or guidelines pooled it, 249 citations in OpenAlex.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- [S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Observational studies of early versus late salvage therapies in critical care exhibit intrinsic selection bias: two meta-analyses.Critical care (London, England) · 2025Pooled it
- Sex and gender considerations in randomized controlled trials in critical care nephrology: a meta-epidemiologic study.BMC medicine · 2025Pooled it
- Eligibility Criteria of Randomized Clinical Trials in Critical Care Medicine.JAMA network open · 2025Pooled it
- Pooled it
- Pooled it
- APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.Hepatology international · 2024Guideline
- Timing of kidney replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2022Pooled it
- The Efficacy and Safety of Early Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials.Frontiers in medicine · 2022Pooled it
- Guidelines for hospital nephrology assistance from the Brazilian Society of Nephrology (BSN).Jornal brasileiro de nefrologiaGuideline
- Automated Electronic Alert for the Care and Outcomes of Adults With Acute Kidney Injury: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Probiotics in septic acute kidney injury, a double blind, randomized control trial.Renal failure · 2023Trial
- Fluid balance and renal replacement therapy initiation strategy: a secondary analysis of the STARRT-AKI trial.Critical care (London, England) · 2022Trial
- Trial
- Clinical practice guideline for renal replacement therapy in critically ill patients with acute kidney injury (2026 edition).Journal of intensive medicine · 2026Article
- Occupational heatstroke-induced acute kidney injury: a narrative review of mechanisms, biomarkers, and the timing of blood purification initiation.Renal failure · 2026Review
- Low-intensity versus medium-intensity continuous renal replacement therapy for critically ill patients (LIMIT) trial: Protocol summary and statistical analysis plan of a randomised clinical trial.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Neonatal continuous kidney replacement therapy.Pediatric nephrology (Berlin, Germany) · 2026Review
- Time from acute kidney injury to continuous renal replacement therapy and outcomes in critically ill children.Clinical kidney journal · 2026Article
81 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
44 authors at 20 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury and no severe complication is safe and allows optimisation of the use of medical devices. Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy.
methodsThis was an unmasked, multicentre, prospective, open-label, randomised, controlled trial done in 39 intensive care units in France. We monitored critically ill patients with severe acute kidney injury (defined as Kidney Disease: Improving Global Outcomes stage 3) until they had oliguria for more than 72 h or a blood urea nitrogen concentration higher than 112 mg/dL. Patients were then randomly assigned (1:1) to either a strategy (delayed strategy) in which RRT was started just after randomisation or to a more-delayed strategy. With the more-delayed strategy, RRT initiation was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen concentration reached 140 mg/dL. The primary outcome was the number of days alive and free of RRT between randomisation and day 28 and was done in the intention-to-treat population. The study is registered with ClinicalTrial.gov, NCT03396757 and is completed.
findingsBetween May 7, 2018, and Oct 11, 2019, of 5336 patients assessed, 278 patients underwent randomisation; 137 were assigned to the delayed strategy and 141 to the more-delayed strategy. The number of complications potentially related to acute kidney injury or to RRT were similar between groups. The median number of RRT-free days was 12 days (IQR 0-25) in the delayed strategy and 10 days (IQR 0-24) in the more-delayed strategy (p=0·93). In a multivariable analysis, the hazard ratio for death at 60 days was 1·65 (95% CI 1·09-2·50, p=0·018) with the more-delayed versus the delayed strategy. The number of complications potentially related to acute kidney injury or renal replacement therapy did not differ between groups.
interpretationIn severe acute kidney injury patients with oliguria for more than 72 h or blood urea nitrogen concentration higher than 112 mg/dL and no severe complication that would mandate immediate RRT, longer postponing of RRT initiation did not confer additional benefit and was associated with potential harm.
fundingProgramme Hospitalier de Recherche Clinique.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.