Gaudry S, Hajage D, Martin-Lefevre L, et al. - Given that a safe strategy in critically ill patients with severe acute kidney injury and no severe complication is to delay renal replacement therapy (RRT) for some time and this enables optimisation of the use of medical devices, researchers undertook this unmasked, multicentre, prospective, open-label, randomised, controlled trial in France to investigate whether more RRT-free days would be offered by a more-delayed initiation strategy vs a delayed strategy. Herein, critically ill patients with severe acute kidney injury were monitored until they suffered oliguria for more than 72 h or had a blood urea nitrogen level higher than 112 mg/dL. Then, randomization was done (1:1) to either a strategy (delayed strategy) wherein RRT was initiated just post-randomisation or to a more-delayed strategy in which RRT start was postponed until mandatory indication (noticeable hyperkalaemia or metabolic acidosis or pulmonary oedema) or until blood urea nitrogen level reached 140 mg/dL. Findings revealed that additional benefit was not gained with longer postponing of RRT initiation and also this strategy was related to potential harm in this study sample of severe acute kidney injury patients who experienced oliguria for more than 72 h or had a blood urea nitrogen level higher than 112 mg/dL and no severe complication that would mandate immediate RRT.