RENAL

STARRT AKI trial. In patients with severe acute kidney injury (AKI) but no urgent indication for renal replacement therapy (RRT), the optimal time to initiate RRT remains controversial. While starting RRT preemptively may have benefits, this may expose patients to unnecessary RRT. To study this, we conducted a 12-center open-label pilot trial of critically ill adults with volume replete severe AKI. Patients were randomized to accelerated (12h or less from eligibility) or standard RRT initiation. No safety signal was evident in either arm. Our findings can inform the design of a large-scale effectiveness randomized control trial.