Trial reportCritical care (London, England)2022
Fluid balance and renal replacement therapy initiation strategy: a secondary analysis of the STARRT-AKI trial.
Trial report in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02568722 (STandard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury), which is not on this map. Cited by 16 papers.
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.
STandard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI): A Multi-Centre, Randomized, Controlled Trial (Principal Trial)
Who cites it
16 citing papers in PubMed, 31 citations in OpenAlex.
- Regional Practice Variation in the Management of Renal Replacement Therapy Modalities in the STARRT-AKI Trial.Blood purification · 2025Trial
- Fluid balance neutralization secured by hemodynamic monitoring versus protocolized standard of care in patients with acute circulatory failure requiring continuous renal replacement therapy: results of the GO NEUTRAL randomized controlled trial.Intensive care medicine · 2024Trial
- Volume control strategy and patient survival in sepsis-associated acute kidney injury receiving continuous renal replacement therapy: a randomized controlled trial with secondary analysis.Scientific reports · 2024Trial
- Association of active fluid de-escalation timing with clinical outcomes in patients with septic shock: a multicenter cohort study.BMC infectious diseases · 2026Article
- Hemoglobin variability predicts mortality in acute kidney injury patients undergoing continuous renal replacement therapy: a multi-database cohort study.Renal failure · 2025Article
- Professor Rinaldo Bellomo: Founder, architect, and choreographer of critical care nephrology.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Review
- Timing of initiating renal replacement therapy in acute kidney injury.Journal of intensive medicine · 2025Article
- Trajectories of fluid management after the initiation of renal replacement therapy in critically ill patients: a secondary analysis of the STARRT-AKI trial.Critical care (London, England) · 2025Article
- The impact of initiation timing of continuous renal replacement therapy on outcomes in critically ill patients with acute kidney injury a retrospective study from the MIMIC-IV database.Scientific reports · 2025Article
- Persistent severe acute kidney injury is a major modifiable determinant of outcome during critical illness.Intensive care medicine · 2025Article
- Article
- Influence of fluid accumulation on major adverse kidney events in critically ill patients - an observational cohort study.Annals of intensive care · 2024Article
- Fluid balance, biomarkers of renal function and mortality in critically ill patients with AKI diagnosed before, or within 24 h of intensive care unit admission: a prospective study.Journal of nephrology · 2024Article
- Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults.JAMA network open · 2024Article
- Current Fluid Management Practice in Critically Ill Adults on Continuous Renal Replacement Therapy: A Binational, Observational Study.Blood purification · 2024Observational
- Current management of fluid balance in critically ill patients with acute kidney injury: A scoping review.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 14 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAmong critically ill patients with acute kidney injury (AKI), earlier initiation of renal replacement therapy (RRT) may mitigate fluid accumulation and confer better outcomes among individuals with greater fluid overload at randomization.
methodsWe conducted a pre-planned post hoc analysis of the STandard versus Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial. We evaluated the effect of accelerated RRT initiation on cumulative fluid balance over the course of 14 days following randomization using mixed models after censoring for death and ICU discharge. We assessed the modifying effect of baseline fluid balance on the impact of RRT initiation strategy on key clinical outcomes. Patients were categorized in quartiles of baseline fluid balance, and the effect of accelerated versus standard RRT initiation on clinical outcomes was assessed in each quartile using risk ratios (95% CI) for categorical variables and mean differences (95% CI) for continuous variables.
resultsAmong 2927 patients in the modified intention-to-treat analysis, 2738 had available data on baseline fluid balance and 2716 (92.8%) had at least one day of fluid balance data following randomization. Over the subsequent 14 days, participants allocated to the accelerated strategy had a lower cumulative fluid balance compared to those in the standard strategy (4509 (- 728 to 11,698) versus 5646 (0 to 13,151) mL, p = 0.03). Accelerated RRT initiation did not confer greater 90-day survival in any of the baseline fluid balance quartiles (quartile 1: RR 1.11 (95% CI 0.92 to 1.34), quartile 2: RR 1.03 (0.87 to 1.21); quartile 3: RR 1.08 (95% CI 0.91 to 1.27) and quartile 4: RR 0.87 (95% CI 0.73 to 1.03), p value for trend 0.08).
conclusionsEarlier RRT initiation in critically ill patients with AKI conferred a modest attenuation of cumulative fluid balance. Nonetheless, among patients with greater fluid accumulation at randomization, accelerated RRT initiation did not have an impact on all-cause mortality.
trial registrationClinicalTrials.gov number, https://clinicaltrials.gov/ct2/show/NCT02568722 , registered October 6, 2015.
Indexed as
Identifiers
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.