We have previously shown that an Outreach service has potential to improve outcomes (Thomas et al, 2011). We present the Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) study, a large pilot study for a cluster randomised trial of AKI Outreach. AKORDD is the first registered controlled trial in unselected AKI in UK. The intervention site was Heartlands Hospital and surrounding area; the Control site was Good Hope Hospital and area. An initial 8 week Before phase was conducted at two acute hospitals (9 miles apart) and their respective catchment areas. In the After phase, an AKI outreach service operated for the intervention hospital/area (Heartlands) for 20 weeks, with the other site (Good Hope) acting as a control. The Outreach team was run in working hours on weekdays. All AKI alerts (stages 1-3, based on the national algorithm) in both hospital and community patients were potentially eligible. The major exclusion criteria were: patients at end of life, or those felt unlikely to benefit from Outreach, patients lacking mental capacity, and patients already conventionally referred to the Renal team. The intervention arm included a model of escalation of renal care to AKI patients. All stage 2 and 3 patients were discussed with a Nephrologist, with all stage 3 patients to be seen by a Nephrologist whilst they were inpatients. Surviving stage 3 patients were offered early specialist follow up. The 30 day primary outcome was a combination of death, or deterioration, as shown by any dialysis or progression in AKI stage. This pilot was powered to determine the rate of the combined outcome, but was not powered to show a difference between groups. 1762 patients were recruited, 744 at the Intervention site during the After phase. 1428 further patients were excluded. A median of 2.7 non drug recommendations and 0.5 drug recommendations were made per patient by the Outreach team, a median of 15.7 hours after the AKI alert. Fidelity was assessed in a sample of 20 patients, and 64 of 78 (82%) recommendations were adhered to. 85 of the 104 patients (82%) with a stage 3 alert during the study received a Nephrologist inpatient review. Of the 71 patients with stage 3 alerts who survived to discharge, and were not end of life, 58 (82%) had an outpatient review by a Nephrologist or other specialist. Relatively low rates of the primary outcomes of death within 30 days (11-15%), or requirement for any renal replacement therapy (RRT, 0.4 – 3.7%) were seen across all four groups. At the Intervention hospital during the After phase there was a lower odds ratio for the combined primary outcome, OR 0.80 (95% CI 0.49, 1.32), but this was not significant (p = 0.39). An AKI outreach service triggered by a laboratory alert system has the potential to deliver standardised specialist care to those with AKI across a healthcare economy. A non-significant trend to a better combined outcome for AKI was seen in patients where there was an AKI outreach service. This study was carried out during increasing awareness and improving outcomes for AKI in the UK. Recognising this, and the exclusions in the study, may account for the rate of adverse outcomes being lower than expected. Trials assessing AKI outreach may well benefit from focusing on those patients with "mid range" prognosis, where nephrological intervention could have the most impact.