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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/study/NCT02568722




Registration number
NCT02568722
Ethics application status
Date submitted
29/09/2015
Date registered
6/10/2015
Date last updated
18/10/2024

Titles & IDs
Public title
Standard vs. Accelerated Initiation of RRT in Acute Kidney Injury (STARRT-AKI: Principal Trial)
Scientific title
STandard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI): A Multi-Centre, Randomized, Controlled Trial (Principal Trial)
Secondary ID [1] 0 0
STARRT-AKI: Principal Trial
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Acute Kidney Injury 0 0
Condition category
Condition code
Renal and Urogenital 0 0 0 0
Kidney disease
Injuries and Accidents 0 0 0 0
Other injuries and accidents
Skin 0 0 0 0
Other skin conditions

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Other interventions - Standard RRT initiation
Other interventions - Accelerated RRT initiation

Active comparator: Standard RRT initiation - RRT initiation will be guided by the presence of one or more clinical indications. Even in the absence of one of these indications, RRT may be commenced at the discretion of the treating physician.

Experimental: Accelerated RRT initiation - A dialysis catheter will be placed and RRT initiated as soon as possible and within 12 hours of the patient meeting the eligibility criteria.


Other interventions: Standard RRT initiation
In the absence of kidney function recovery, the initiation of RRT will be permitted if one of the following develops:

serum potassium = 6.0 mmol/L; pH = 7.20 or serum bicarbonate = 12 mmol/L; evidence of severe respiratory failure, based on a PaO2/FiO2 = 200 and clinical perception of volume overload; and/or persistent AKI \> 72 hours following the time of randomization.

Other interventions: Accelerated RRT initiation
A dialysis catheter will be placed and RRT initiated as soon as possible and within 12 hours of eligibility. This 12 hour window includes the time needed to obtain consent.
Intervention code [1] 0 0
Other interventions
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
All-cause Mortality.
Timepoint [1] 0 0
90 days following study randomization.
Secondary outcome [1] 0 0
RRT Dependence
Timepoint [1] 0 0
90 days following study randomization.
Secondary outcome [2] 0 0
Composite of Death or RRT Dependence.
Timepoint [2] 0 0
90 days following study randomization.
Secondary outcome [3] 0 0
Measurement of Estimated Glomerular Filtration Rate.
Timepoint [3] 0 0
90 days following study randomization.
Secondary outcome [4] 0 0
Measurement of Albuminuria.
Timepoint [4] 0 0
90 days following study randomization.
Secondary outcome [5] 0 0
Major Adverse Kidney Outcomes.
Timepoint [5] 0 0
90 days following study randomization.
Secondary outcome [6] 0 0
Mechanical Ventilation-free Days.
Timepoint [6] 0 0
Measured from randomization through day 28.
Secondary outcome [7] 0 0
Vasoactive Therapy-free Days
Timepoint [7] 0 0
Measured from randomization through day 28.
Secondary outcome [8] 0 0
ICU-free Days
Timepoint [8] 0 0
Measured from randomization through day 28.
Secondary outcome [9] 0 0
Hospitalization-free Days
Timepoint [9] 0 0
Measured from randomization through day 90.
Secondary outcome [10] 0 0
Death in ICU
Timepoint [10] 0 0
Measured in-hospital and at day 28.
Secondary outcome [11] 0 0
EuroQoL EQ-5D-5L.
Timepoint [11] 0 0
Measured at day 90 and at day 365.
Secondary outcome [12] 0 0
Health Care Costs.
Timepoint [12] 0 0
Measured from baseline through day 365.
Secondary outcome [13] 0 0
Composite of Death or RRT Dependence.
Timepoint [13] 0 0
Measured at day 365.

Eligibility
Key inclusion criteria
1. Age = 18 years
2. Admission to an intensive care unit (ICU)
3. Evidence of kidney dysfunction [serum creatinine =100 µmol/L (women) and = 130 µmol/L (men)]
4. Evidence of severe AKI defined by at least 1 of the following 3 criteria:

i) = 2-fold increase in serum creatinine from a known pre-morbid baseline or during the current hospitalization; OR ii) Achievement of a serum creatinine = 354 µmol/L with evidence of a minimum increase of 27 µmol/L from pre-morbid baseline or during the current hospitalization; OR iii) Urine output < 6.0 mL/kg over the preceding 12 hours
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
1. Serum potassium > 5.5 mmol/L
2. Serum bicarbonate < 15 mmol/L
3. Presence of a drug overdose that necessitates initiation of RRT
4. Lack of commitment to ongoing life support (including RRT)
5. Any RRT within the previous 2 months (either acute or chronic RRT)
6. Kidney transplant within the past 365 days
7. Known pre-hospitalization advanced chronic kidney disease, defined by an estimated glomerular filtration rate < 20 mL/min/1.73 m2
8. Presence or clinical suspicion of renal obstruction, rapidly progressive glomerulonephritis, vasculitis, thrombotic microangiopathy or acute interstitial nephritis
9. Clinician(s) caring for patient believe(s) that immediate RRT is mandated
10. Clinician(s) caring for patient believe(s) that deferral of RRT initiation is mandated

* at their discretion, clinicians may administer a bolus of intravenous furosemide (ie, "furosemide stress test") and evaluate the subsequent urine output to help guide decision making regarding the likelihood of AKI progression

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Not applicable
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
1/10/2015
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
1/12/2019
Sample size
Target
Accrual to date
Final
3019
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 0 0
Ballarat Hospital - Ballarat
Recruitment hospital [2] 0 0
Flinder Medical Centre - Bedford Park
Recruitment hospital [3] 0 0
Bendigo Hospital - Bendigo
Recruitment hospital [4] 0 0
Eastern Hospital (Box Hill and Maroondah Hospital) - Box Hill
Recruitment hospital [5] 0 0
Concord Hospital - Concord
Recruitment hospital [6] 0 0
The Northern Hospital - Epping
Recruitment hospital [7] 0 0
Geelong Hospital - Geelong
Recruitment hospital [8] 0 0
Austin Hospital - Heidelberg
Recruitment hospital [9] 0 0
Nepean Hospital - Kingswood
Recruitment hospital [10] 0 0
The Alfred Hospital - Melbourne
Recruitment hospital [11] 0 0
Nambour General Hospital - Nambour
Recruitment hospital [12] 0 0
Western Health (Footscray Hospital & Sunshine Hospital) - St Albans
Recruitment hospital [13] 0 0
St. Vincent's Hospital - Sydney
Recruitment hospital [14] 0 0
Royal North Shore Hospital - Sydney
Recruitment hospital [15] 0 0
Royal Prince Alfred Hospital - Sydney
Recruitment hospital [16] 0 0
Princess Alexandra Hospital - Woolloongabba
Recruitment postcode(s) [1] 0 0
3350 - Ballarat
Recruitment postcode(s) [2] 0 0
5042 - Bedford Park
Recruitment postcode(s) [3] 0 0
3550 - Bendigo
Recruitment postcode(s) [4] 0 0
- Box Hill
Recruitment postcode(s) [5] 0 0
2139 - Concord
Recruitment postcode(s) [6] 0 0
3076 - Epping
Recruitment postcode(s) [7] 0 0
3220 - Geelong
Recruitment postcode(s) [8] 0 0
3084 - Heidelberg
Recruitment postcode(s) [9] 0 0
NSW 2747 - Kingswood
Recruitment postcode(s) [10] 0 0
- Melbourne
Recruitment postcode(s) [11] 0 0
QLD 4560 - Nambour
Recruitment postcode(s) [12] 0 0
VIC 3021 - St Albans
Recruitment postcode(s) [13] 0 0
2010 - Sydney
Recruitment postcode(s) [14] 0 0
2065 - Sydney
Recruitment postcode(s) [15] 0 0
- Sydney
Recruitment postcode(s) [16] 0 0
- Woolloongabba
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Alabama
Country [2] 0 0
United States of America
State/province [2] 0 0
Florida
Country [3] 0 0
United States of America
State/province [3] 0 0
Kentucky
Country [4] 0 0
United States of America
State/province [4] 0 0
Minnesota
Country [5] 0 0
United States of America
State/province [5] 0 0
Rhode Island
Country [6] 0 0
Austria
State/province [6] 0 0
Graz
Country [7] 0 0
Austria
State/province [7] 0 0
Innsbruck
Country [8] 0 0
Austria
State/province [8] 0 0
Wien
Country [9] 0 0
Belgium
State/province [9] 0 0
Edegem
Country [10] 0 0
Belgium
State/province [10] 0 0
Ghent
Country [11] 0 0
Brazil
State/province [11] 0 0
Rio Branco
Country [12] 0 0
Canada
State/province [12] 0 0
Alberta
Country [13] 0 0
Canada
State/province [13] 0 0
British Columbia
Country [14] 0 0
Canada
State/province [14] 0 0
Manitoba
Country [15] 0 0
Canada
State/province [15] 0 0
Newfoundland and Labrador
Country [16] 0 0
Canada
State/province [16] 0 0
Ontario
Country [17] 0 0
Canada
State/province [17] 0 0
Quebec
Country [18] 0 0
Canada
State/province [18] 0 0
Saskatchewan
Country [19] 0 0
China
State/province [19] 0 0
Beijing
Country [20] 0 0
China
State/province [20] 0 0
Changchun
Country [21] 0 0
China
State/province [21] 0 0
Changsha
Country [22] 0 0
China
State/province [22] 0 0
Guiyang
Country [23] 0 0
China
State/province [23] 0 0
Jinan
Country [24] 0 0
China
State/province [24] 0 0
Nanjing
Country [25] 0 0
China
State/province [25] 0 0
Wuhan
Country [26] 0 0
China
State/province [26] 0 0
Xi'an
Country [27] 0 0
China
State/province [27] 0 0
Xiamen
Country [28] 0 0
China
State/province [28] 0 0
Zhengzhou
Country [29] 0 0
Finland
State/province [29] 0 0
Helsinki
Country [30] 0 0
Finland
State/province [30] 0 0
Tampere
Country [31] 0 0
Finland
State/province [31] 0 0
Turku
Country [32] 0 0
France
State/province [32] 0 0
Colombes
Country [33] 0 0
Germany
State/province [33] 0 0
Coburg
Country [34] 0 0
Germany
State/province [34] 0 0
Münster
Country [35] 0 0
Ireland
State/province [35] 0 0
Dublin
Country [36] 0 0
Italy
State/province [36] 0 0
Milano
Country [37] 0 0
New Zealand
State/province [37] 0 0
Auckland
Country [38] 0 0
New Zealand
State/province [38] 0 0
Christchurch
Country [39] 0 0
New Zealand
State/province [39] 0 0
Hastings
Country [40] 0 0
New Zealand
State/province [40] 0 0
Rotorua
Country [41] 0 0
New Zealand
State/province [41] 0 0
Wellington
Country [42] 0 0
Switzerland
State/province [42] 0 0
Lausanne
Country [43] 0 0
United Kingdom
State/province [43] 0 0
Aylesbury
Country [44] 0 0
United Kingdom
State/province [44] 0 0
High Wycombe
Country [45] 0 0
United Kingdom
State/province [45] 0 0
Leeds
Country [46] 0 0
United Kingdom
State/province [46] 0 0
London
Country [47] 0 0
United Kingdom
State/province [47] 0 0
Nottingham
Country [48] 0 0
United Kingdom
State/province [48] 0 0
Orpington

Funding & Sponsors
Primary sponsor type
Other
Name
Unity Health Toronto
Address
Country
Other collaborator category [1] 0 0
Government body
Name [1] 0 0
Canadian Institutes of Health Research (CIHR)
Address [1] 0 0
Country [1] 0 0
Other collaborator category [2] 0 0
Other
Name [2] 0 0
National Health and Medical Research Council, Australia
Address [2] 0 0
Country [2] 0 0
Other collaborator category [3] 0 0
Commercial sector/industry
Name [3] 0 0
Baxter Healthcare Corporation
Address [3] 0 0
Country [3] 0 0
Other collaborator category [4] 0 0
Other
Name [4] 0 0
The George Institute
Address [4] 0 0
Country [4] 0 0
Other collaborator category [5] 0 0
Government body
Name [5] 0 0
National Institute for Health Research, United Kingdom
Address [5] 0 0
Country [5] 0 0
Other collaborator category [6] 0 0
Other
Name [6] 0 0
Medical Research Institute of New Zealand
Address [6] 0 0
Country [6] 0 0
Other collaborator category [7] 0 0
Other
Name [7] 0 0
Health Research Council, New Zealand
Address [7] 0 0
Country [7] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
The objectives of this trial are to determine whether, in critically ill patients with severe acute kidney injury (AKI), randomization to accelerated initiation of renal replacement therapy (RRT), compared to standard initiation, leads to:

1. Improved survival (primary outcome); and
2. Recovery of kidney function (principal secondary outcome), defined as independence from RRT at 90 days
Trial website
https://clinicaltrials.gov/study/NCT02568722
Trial related presentations / publications
STARRT-AKI Investigators; Canadian Critical Care Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group; United Kingdom Critical Care Research Group; Canadian Nephrology Trials Network; Irish Critical Care Trials Group; Bagshaw SM, Wald R, Adhikari NKJ, Bellomo R, da Costa BR, Dreyfuss D, Du B, Gallagher MP, Gaudry S, Hoste EA, Lamontagne F, Joannidis M, Landoni G, Liu KD, McAuley DF, McGuinness SP, Neyra JA, Nichol AD, Ostermann M, Palevsky PM, Pettila V, Quenot JP, Qiu H, Rochwerg B, Schneider AG, Smith OM, Thome F, Thorpe KE, Vaara S, Weir M, Wang AY, Young P, Zarbock A. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med. 2020 Jul 16;383(3):240-251. doi: 10.1056/NEJMoa2000741. Erratum In: N Engl J Med. 2020 Jul 30;383(5):502. doi: 10.1056/NEJMx200016.
STARRT-AKI Investigators. Statistical analysis plan for the Standard versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial. Crit Care Resusc. 2019 Sep;21(3):162-170.
STARRT-AKI Investigators. STandard versus Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury: Study Protocol for a Multi-National, Multi-Center, Randomized Controlled Trial. Can J Kidney Health Dis. 2019 Jun 10;6:2054358119852937. doi: 10.1177/2054358119852937. eCollection 2019.
Public notes

Contacts
Principal investigator
Name 0 0
Ron Wald, MDCM MPH
Address 0 0
Unity Health Toronto
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/study/NCT02568722