Acute kidney injury (AKI) affects>50% of critically ill patients and is associated with considerable morbidity and mortality.1 Initiation of kidney replacement therapy (KRT) is the standard of care when AKI leads to life-threatening complications such as severe hyperkalemia, metabolic acidosis, or diuretic-resistant volume overload. However, the optimal timing of KRT initiation remains unclear. On the one hand, an early initiation strategy may theoretically maintain physiologic balance and avoid harm from volume overload and metabolic derangements.