Delaying renal replacement therapy (RRT) for some time in critically ill patients with severe acute kidney injury (AKI) and no severe complication is safe and allows optimisation of the use of medical devices.

Major uncertainty remains concerning the duration for which RRT can be postponed without risk. Our aim was to test the hypothesis that a more-delayed initiation strategy would result in more RRT-free days, compared with a delayed strategy.

This was an unmasked, multicentre, prospective, open-label, randomised, controlled trial done in 39 intensive care units in France.

Between May 7, 2018, and Oct 11, 2019, of 5,336 patients assessed, 278 patients underwent randomisation; 137 were assigned to the delayed strategy and 141 to the more-delayed strategy.

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