Background <p>Renal replacement therapy is increasingly used in tertiary emergency departments, particularly for urgent cases of renal failure or poisoning.</p> Aims <p>This study aims to identify patients who were urgently admitted to the emergency department for dialysis. To investigate the impact of the time interval between emergency department admission and initiation of dialysis, as well as biochemical parameters, on outcomes in the emergency department and during hospitalization.</p> Methods <p>A prospective observational study was conducted on patients who received emergency dialysis in a tertiary university hospital’s emergency department between October 1, 2021, and October 1, 2022.</p> Results <p>Among 151 patients, 37.8% were on routine dialysis, and 62.2% received dialysis for the first time. Regarding emergency department outcomes, 15.2% were discharged, 29.8% were hospitalized, 47% were transferred for ICU care, and 7.9% died. Hospital outcomes showed 23.8% discharged, 19.9% died, and 56.3% had unknown outcomes due to inter-hospital transfer. A longer interval between admission and initiation of dialysis was significantly associated with poorer outcomes in the emergency department.</p> Conclusion <p>Early intervention, hemodynamic stability, and the correction of acidosis and electrolyte imbalances are essential for better clinical outcomes in patients undergoing extracorporeal therapy in the emergency setting. Furthermore, systemic factors such as organizational delays, limited dialysis unit capacity, and insufficient patient education were found to negatively affect patient outcomes.</p>