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The following is a summary of “Time to Renal Replacement Therapy Initiation in Critically Ill Patients With Acute Kidney Injury: A Secondary Analysis of the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial,” published in the March 2025 issue of Critical Care Medicine by Jeong et al. 

Researchers conducted a retrospective study to assess the association between progressively longer delays in renal replacement therapy (RRT) initiation and clinical outcomes in individuals with critical illness and severe acute kidney injury (AKI).  

They analyzed data from the multinational Standard vs Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial. Participants included those assigned to the standard strategy of the STARRT-AKI trial. The exposure variable was the time from randomization to RRT initiation, assessed in quartiles and as a continuous variable.  

The results showed that all-cause mortality at 90 days was the primary outcome, while secondary outcomes were RRT dependence, RRT-free days, hospital-free days, and ICU and hospital stay, all assessed at 90 days. Among 1,462 participants in the standard strategy group, 903 (62%) received RRT. Median time to RRT initiation was 12.1 hours (interquartile range 8.3–13.8 hr), 24.5 hours (21.8–26.5 hr), 46.8 hours (35.2–52.1 hr), and 96.1 hours (76.7–139.2 hr) across quartiles 1–4. A prolonged delay in RRT initiation was linked to a lower 90-day mortality risk (quartile 4 vs 1: adjusted odds ratio 0.63 [95% CI 0.42–0.94]). However, analyses using cubic splines and inverse probability weighting found no mortality association. Time to RRT initiation showed no correlation with RRT-free days, hospital-free days, or ICU and hospital length of stay, but longer delays had a linear association with RRT dependence at 90 days.  

Investigators concluded that delaying RRT initiation in stable patients with AKI did not increase mortality within the STARRT-AKI trial’s standard strategy. 

Source: journals.lww.com/ccmjournal/abstract/9900/time_to_renal_replacement_therapy_initiation_in.487.aspx