In critically ill patients with acute kidney injury (AKI), does early initiation of renal replacement therapy (RRT) improve outcomes compared to delayed initiation? This pivotal randomized controlled trial evaluated the impact of early versus delayed initiation of RRT in ICU patients with AKI. The early initiation group, where RRT was started within 8 hours of fulfilling KDIGO stage 2 AKI criteria, experienced significantly lower 90-day mortality compared to the delayed group, in which RRT was initiated only after meeting stage 3 AKI criteria or severe complications. Additionally, early RRT was associated with improved renal recovery and shorter duration of RRT dependency. Importantly, there was no significant increase in adverse events, such as hemodynamic instability, in the early RRT group. The findings highlighted the potential benefits of early intervention in critically ill patients with AKI to improve survival and long-term renal outcomes.