Naorungroj T, Neto AS, Yanase F, et al. - Since there exists controversy about the optimal time to start renal replacement therapy in critically ill patients with acute kidney injury, researchers here assessed the impact of such earlier vs later commencement of renal replacement therapy on 28-day mortality (the primary outcome) as well as on other patient-centered secondary outcomes. They explored MEDLINE (via PubMed), EMBASE, and Cochrane databases to find relevant randomized controlled trials. They analyzed eight trials with 4,588 participants. Findings revealed that mortality remained unaffected by earlier or later initiation of renal replacement therapy. However, significantly shorter ICU and hospital length of stay was noted in relation to earlier renal replacement therapy, whereas reduced use of renal replacement therapy as well as reduced risk of catheter-related blood stream infection were observed in relation to later renal replacement therapy.