How does the intensity of renal support influence outcomes in critically ill patients with acute kidney injury (AKI)? The VA/NIH Acute Renal Failure Trial Network study addressed this by comparing two levels of renal support: intensive and lessintensive treatment strategies. This multicenter, randomized controlled trial involved 1124 patients with severe AKI who were randomly assigned to receive either an intensive treatment strategy or a less-intensive strategy. In the intensive treatment group, patients underwent intermittent hemodialysis (IHD) or sustained low-efficiency dialysis (SLED) six times per week; hemodynamically unstable patients underwent continuous venovenous hemodiafiltration (CVVHDF) was carried out at a rate of 35 ml per kilogram of body weight per hour. In contrast, the less-intensive treatment group received IHD or SLED three times per week; CVVHDF was delivered at a rate of 20 ml per kilogram per hour in hemodynamically unstable patients. The results showed no significant difference in 60-day mortality between the two groups. Furthermore, there was no significant difference in the recovery of kidney function or other secondary outcomes. The study concluded that more intensive renal support did not result in improved survival or kidney recovery compared to less-intensive strategies. These findings suggest that less aggressive renal replacement therapies may be sufficient for critically ill patients with severe AKI.