Chen JJ, Lee CC, Kuo G, et al. - Researchers analyzed 9 randomized controlled trials (RCTs) with 1,938 patients, to determine how the acute kidney injury (AKI) population with high plasma neutrophil gelatinase-associated lipocalin (NGAL) is influenced by early renal replacement therapy (RRT) initiation. The included RCTs were systemically identified from the PubMed, Embase, and Cochrane databases. Trials not performed in the AKI population were dismissed. Findings revealed no survival benefit of early RRT initiation, but there was a likely benefit of fewer mechanical ventilation (MV) days. The benefit of shorter MV or RRT support might be afforded by early RRT in the surgical population and in AKI patients with high plasma NGAL. Based on the conventional indication for RRT start, the watchful waiting strategy was identified as safe considering all primary and secondary outcomes (all-cause mortality, MV days, length of hospital stay, RRT days, and length of ICU stay).