Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury

To the Editor: In their article on the results of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial, Bagshaw et al. (July 16 issue) 1 report that the accelerated initiation of dialysis, as compared with a standard strategy, resulted in similar mortality among patients with acute kidney injury. Although the causes of death seemed to be similar in the two groups, four patients in the standard-strategy group died of hyperkalemia (Table S9 in the Supplementary Appendix accompanying the article, available at NEJM.org). In a comparison of the time until the initiation of renal-replacement therapy after . . .