Grant: Project Grant

Background: Sick patients receiving care in the intensive care unit (ICU) commonly develop acute injury to their kidneys. This sudden loss of kidney function predisposes these patients to the accumulation of fluid and blood toxins and often leads to death. Acute kidney injury often prompts clinicians to start dialysis therapy, which involves passing a patient's blood through a specialized filter to remove excess fluid and metabolic waste. However, the right time to start dialysis is not clearly known to clinicians. Starting dialysis early or proactively can help better control fluid and blood toxin levels and may lead to a lower risk of death. On the other hand, dialysis has side effects and is expensive and if early dialysis does not improve patient outcomes, it may be best to only start it when the patient gets much sicker and the clinician does not believe there is any other choice. Aims: This study will establish which one of two strategies for starting dialysis (accelerated/early vs. standard) in ICU patients with acute kidney injury leads to a lower risk of death and non-recovery of kidney function and which approach is more cost-effective. Design: This study is an international, multicentre, randomized clinical trial comparing early vs. standard start of dialysis in 2866 critically ill ICU patients with acute kidney injury. Significance: The study will guide clinical practice and inform policy on when to start dialysis in ICU patients with acute kidney injury. The trial has enrolled 970 participants (34% target) from active 90 sites across 10 countries and has fostered extraordinary collaboration with endorsement from critical care trials groups and medical organizations around the world. These funds will enable us to complete recruitment and perform a rigorous cost comparison of these two approaches to starting dialysis in ICU patients.