Early-start vs. conventional-start peritoneal dialysis in AKI from cardiorenal syndrome type 1: a randomized controlled trial (STARRT-PD).
Watanyu Parapiboon, Suriyan Yupaniad, Pachara Saengngammongkhol et al.
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In 30 seconds
This randomized, open-label controlled trial compared early-start with conventional-start peritoneal dialysis (PD) in patients with cardiorenal syndrome type 1 and stage II acute kidney injury at a tertiary hospital in Thailand. In the modified intention-to-treat analysis of 53 participants, 30-day mortality was 65% (17 patients) with early-start PD and 40% (11 patients) with conventional-start PD (relative risk 1.68; 95% confidence interval 0.92-3.07; p = 0.07). The groups had comparable fluid balance and sodium removal over the first 5 days; PD-related complications occurred in 6 versus 3 events, respectively.
Key findings
- Thirty-day mortality was 65% (17 patients) with early-start PD versus 40% (11 patients) with conventional-start PD (relative risk 1.68; 95% confidence interval 0.92-3.07; p = 0.07).
- PD was initiated in 26 patients (100%) in the early-start group and 11 patients (40%) in the conventional-start group.
- First 5-day fluid balance and sodium removal were comparable between groups.
- PD-related complications occurred in 6 events with early-start and 3 events with conventional-start.
Why it matters
The trial addresses whether starting PD soon after stage II AKI improves outcomes in cardiorenal syndrome type 1. Its results did not demonstrate a lower 30-day mortality risk with early initiation, while fluid balance and sodium removal were similar. These findings help frame the uncertainty around timing, but the mortality estimate remains imprecise and does not establish equivalence between strategies.
What to keep in mind
The modified intention-to-treat analysis included 53 participants, and the open-label trial was conducted at a single tertiary hospital in Thailand. The mortality confidence interval was wide.