• Roberta T Tallarico, Ary S Neto, and Matthieu Legrand.
• Division of Critical Care Medicine, Department of Anesthesia & Perioperative Care, University of California, San Francisco (UCSF), San Francisco, California, USA.
• Curr Opin Crit Care. 2022 Dec 1; 28 (6): 622629622-629.

Purpose Of ReviewThere is an important need for improved diagnostic strategies and treatment among patients with acute kidney injury (AKI). Classical randomized clinical trials have generated relevant results in AKI but are associated with shortcomings, such as high costs and sometimes lack of generalizability. In this minireview, we discuss the value and limits of pragmatic trials and platform trials for AKI research.Recent FindingsThe implementation of pragmatic and platform trials in critical care settings has generated relevant clinical evidence impacting clinical practice. Pragmatic and platform designs have recently been applied to patients at risk of AKI and represent a crucial opportunity to advance our understanding of optimized treatment and strategies in patients at risk of AKI or presenting with AKI. Trials embedded in electronic health records can facilitate patient enrollment and data collection. Platform trials have allowed for a more efficient study design. Although both pragmatic and platform trials have several advantages, they also come with the challenges and shortcomings discussed in this review.SummaryPragmatic and platform trials can provide clinical answers in 'real-life' settings, facilitate a significant sample size enrollment at a limited cost, and provide results that can have a faster implementation in clinical practice.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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