STARRT‐AKI 2019.

Study characteristics
Methods	Study design: parallel, open‐label RCT Duration of study: October 2015 to December 2019 Duration of follow‐up: 90 days
Participants	Setting: multicentre (168 centres) Country: 15 countries Critically ill patients ≥ 18 years and AKI (KDIGO stage 2 or 3) Number: intervention group (1465); control group (1462) Mean age ± SD (years): intervention group (64.6 ± 14.3); control group (63.7 ± 13.4) Sex (M/F): intervention group (995/470); control group (995/467) Exclusion criteria: lack of commitment to ongoing life support, including KRT; presence of an intoxication requiring extracorporeal removal; KRT within the previous 2 months (either acute or chronic KRT); clinical suspicion of renal obstruction, rapidly progressive GN, or acute interstitial nephritis; pre‐hospitalisation eGFR < 20 mL/min/1.73 m²; clinicians caring for patient believes that immediate KRT is absolutely mandated; clinicians caring for patient believe that deferral of KRT initiation is mandated; patient or substitute decision maker is unable to provide consent within 12 hours of determination of study eligibility
Interventions	KRT modality CVVH, IHD, or both Intervention group Accelerated KRT initiation: start of KRT within 12 hours of the patient fulfilling study eligibility Control group Standard KRT initiation: start of KRT when one of the following conditions develop: Serum potassium ≥ 6.0 mmol/L Serum bicarbonate ≤ 12 mmol/L PaO2/FiO2 ≤ 200 with infiltrates on chest radiograph compatible with pulmonary oedema Volume overload and/or AKI persisted > 72 hours following the time of randomisation Co‐interventions Not reported
Outcomes	Primary outcome Death at day 90 Secondary outcomes Dialysis‐dependent at day 90 Composite of death or KRT dependence at day 90 Sustained reduction of kidney function (< 75% baseline eGFR) at day 90 Death in ICU at day 28 Death during hospitalisation Days free of KRT at 90 days Mechanical ventilation‐free days at day 28 Vasoactive therapy‐free days at day 28 ICU‐free days at day 28 Hospitalisation‐free days at day 28 QoL at day 28 and day 365 Health care costs Adverse events Adverse events related to KRT and vascular access
Notes	This study was supported by grants from the Canadian Institutes of Health Research; Baxter Healthcare Corporation, the National Health Medical Research Council of Australia, the Health Research Council of New Zealand, and the Health Technology Assessment Program of the United Kingdom National Institute of Health Research
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Patients were randomly 1:1 to accelerated versus standard initiation of KRT with variable block sizes (2 and 4) and stratified by centre using a centralised concealed web‐based randomisation system
Allocation concealment (selection bias)	Low risk	Central allocation process
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Insufficient information to permit judgement (for kidney recovery was unclear risk but for death was low risk)
Blinding of outcome assessment (detection bias) All outcomes	Low risk	The outcome measurement unlikely to be influenced by lack of blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	Complete outcome data were reported
Selective reporting (reporting bias)	Low risk	The study reported death, kidney function recovery and adverse events
Other bias	Low risk	Quote: "The funding organizations and partners were not involved in the design, implementation, management, analysis, and interpretation of the results".