Delaying Renal Replacement Therapy in Acute Kidney Injury: We Own the Night

Renal replacement therapy (RRT) indication in the context of acute kidney injury (AKI) in intensive care unit is a subject of intense debate. Life-threatening conditions such as refractory and severe metabolic acidosis, refractory and severe hyperkalemia, and severe pulmonary edema, require urgent RRT initiation. In other conditions, high quality studies have recently shown that RRT initiation strategies (early or delayed) do not influence patient survival. Nevertheless, recent data suggest that early RRT initiation could be associated with deleterious effects on renal function recovery. However, some misconceptions persist about the consequences of delaying RRT. This review proposes to discuss putative risks associated with delayed RRT and contends that they are far from constituting a real threat to patients.