Trial reportInternational urology and nephrology2026
Early-start vs. conventional-start peritoneal dialysis in AKI from cardiorenal syndrome type 1: a randomized controlled trial (STARRT-PD).
Trial report in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
purposePeritoneal dialysis (PD) is a feasible option for acute kidney injury (AKI) in hemodynamically unstable patients. However, the optimal timing for initiating PD in cardiorenal syndrome type 1 (CRS1) remains unclear.
methodsIn a cardiac care unit of a tertiary hospital in Thailand, CRS1 patients who had AKI stage II between October 2020 and September 2021 were enrolled in a randomized, open-label controlled study. Patients were randomized into two groups: early-start PD strategy (starting PD within 24 h after AKI stage II) and conventional-start PD strategy (starting PD at 72 h if reaching AKI stage III or with an indication). The primary outcome was 30-day mortality. Secondary outcomes included fluid balance, sodium removal during the first 5 days, and PD safety.
results77 CRS1 patients were enrolled, and 53 eligible participants were included in a modified intention-to-treat analysis (26 in the early-start group and 27 in the conventional-start group). Dialysis was initiated in 26 patients (100%) in the early-start group and 11 patients (40%) in the conventional-start group. The 30-day mortality was 65% (17 patients) in the early-start group and 40% (11 patients) in the conventional-start group (relative risk 1.68; 95% confidence interval 0.92-3.07; p = 0.07). The first 5-day fluid balance and sodium removal were comparable between the two groups. PD-related complications occurred in 6 events (early-start) and 3 events (conventional-start).
conclusionAmong CRS1 patients with AKI, early-start and conventional-start PD showed comparable 30-day mortality risk (Thai Clinical Trial Registry number, TCTR20200928003).
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