Abstract: SA-OR010
One-Year Outcomes of an Accelerated vs. Standard Kidney Replacement Therapy Initiation Strategy for AKI: Results from the STARRT-AKI Trial
Session Information
- AKI Trials, Therapeutics, and Risk Stratification
October 24, 2026 | Location: Room 603, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Chennou, Fella, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Lebovic, Gerald, St Michael's Hospital, Toronto, Ontario, Canada
- Bagshaw, Sean M., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Wald, Ron, St Michael's Hospital, Toronto, Ontario, Canada
Background
There is limited knowledge on the long-term outcomes of severe acute kidney injury (AKI) treated with renal replacement therapy (RRT) beyond the acute phase of critical illness. We performed a secondary analysis of the STARRT-AKI trial, which compared accelerated and standard RRT initiation strategies, to evaluate the effect of treatment allocation on all-cause mortality and RRT dependence, respectively, at one year following randomization. We also evaluated predictors of 1-year mortality and worsened frailty.
Methods
The effect of treatment allocation on 1-year clinical outcomes was evaluated using the chi-square test. Predictors were assessed using multivariable logistic regression. Frailty was measured with the Clinical Frailty Scale (CFS) and compared from baseline to one year. We considered a minimum 1-point increase in CFS to be clinically significant for worsening frailty.
Results
Among the 2927 participants in the intention-to-treat analysis, 1645 were alive at 90 days, of whom vital status was known for 1216 (73.9%) at one year (mean age 62.2 years, 67.8% males). A total of 141 (11.5%) patients died between 90 days and one year with no difference between the accelerated and standard arms (12.6% and 10.6% respectively, p=0.34). RRT dependence was 7.4% in the accelerated group and 5.4% in the standard group (p=0.33). Independent predictors of 1-year mortality were: pre-existing heart failure (OR 1.89, 95% CI 1.11-3.22), metastatic cancer (OR 5.44, 95% CI 2.64-11.21), hematological malignancy (OR 3.06, 95% CI 1.34-7.02), CFS at enrollment (OR 1.54, 95% CI 1.33-1.78 for each unit increase) and being in another facility (including acute, chronic, palliative care units or other) rather than home at 90 days (OR 1.72, 95% CI 1.06-2.77). Among 999 patients with available data, 289 (28.9%) had a 1-point increase or more in CFS. Multivariable analysis did not reveal any independent predictors of worsened CFS.
Conclusion
Accelerated RRT initiation did not confer a difference in mortality or RRT dependence at one year following randomization compared to standard RRT initiation. Pre-existing comorbidities and frailty, rather than markers of acute illness severity, were prominent predictors of 1-year mortality.