The REVIVAL trial evaluated the efficacy and safety of ilofotase alfa, a human recombinant alkaline phosphatase, in patients with sepsis-associated acute kidney injury (SA-AKI). The trial was a phase-3, multi-center, randomized, double-blind, placebo-controlled study involving 650 patients. The primary endpoint was 28-day all-cause mortality, and the main secondary endpoint was Major Adverse Kidney Events (MAKE90) by 90 days. The trial was stopped early for futility due to no significant difference in 28-day mortality between the ilofotase alfa and placebo groups. However, ilofotase alfa showed a trend toward reduced MAKE90 events, primarily due to lower rates of renal replacement therapy (RRT) by day 90. The drug was well tolerated, with no significant safety concerns. The study found no improvement in 28-day survival with ilofotase alfa, but there was evidence of reduced MAKE90 events, which include mortality, new onset of kidney injury, RRT use, and rehospitalization. The effect was more pronounced in patients with pre-existing chronic kidney disease (CKD), particularly those with lower estimated glomerular filtration rate (eGFR) prior to SA-AKI. The results suggest that while ilofotase alfa may not improve survival, it could reduce the risk of major adverse kidney events in patients with SA-AKI, especially those with pre-existing CKD. The trial was conducted in multiple countries and followed strict ethical guidelines. The study highlights the need for further research to confirm the renal protective effects of ilofotase alfa in patients with SA-AKI and pre-existing CKD. The findings are consistent with previous phase-2 trials, which showed a survival benefit, but the current trial did not confirm this, possibly due to differences in patient populations and study design. The results emphasize the importance of considering pre-existing renal function when evaluating the efficacy of treatments for SA-AKI.The REVIVAL trial evaluated the efficacy and safety of ilofotase alfa, a human recombinant alkaline phosphatase, in patients with sepsis-associated acute kidney injury (SA-AKI). The trial was a phase-3, multi-center, randomized, double-blind, placebo-controlled study involving 650 patients. The primary endpoint was 28-day all-cause mortality, and the main secondary endpoint was Major Adverse Kidney Events (MAKE90) by 90 days. The trial was stopped early for futility due to no significant difference in 28-day mortality between the ilofotase alfa and placebo groups. However, ilofotase alfa showed a trend toward reduced MAKE90 events, primarily due to lower rates of renal replacement therapy (RRT) by day 90. The drug was well tolerated, with no significant safety concerns. The study found no improvement in 28-day survival with ilofotase alfa, but there was evidence of reduced MAKE90 events, which include mortality, new onset of kidney injury, RRT use, and rehospitalization. The effect was more pronounced in patients with pre-existing chronic kidney disease (CKD), particularly those with lower estimated glomerular filtration rate (eGFR) prior to SA-AKI. The results suggest that while ilofotase alfa may not improve survival, it could reduce the risk of major adverse kidney events in patients with SA-AKI, especially those with pre-existing CKD. The trial was conducted in multiple countries and followed strict ethical guidelines. The study highlights the need for further research to confirm the renal protective effects of ilofotase alfa in patients with SA-AKI and pre-existing CKD. The findings are consistent with previous phase-2 trials, which showed a survival benefit, but the current trial did not confirm this, possibly due to differences in patient populations and study design. The results emphasize the importance of considering pre-existing renal function when evaluating the efficacy of treatments for SA-AKI.