In critically ill patients with severe acute kidney injury (AKI), does a “more delayed” renal replacement therapy (RRT) strategy provide additional benefits compared to a delayed strategy? This pivotal multicenter, randomized controlled trial evaluated two delayed RRT initiation strategies in ICU patients with severe AKI. Patients in the delayed group began RRT after meeting specific criteria (oliguria >72 hours or blood urea nitrogen >112 mg/dL), while those in the more-delayed group had RRT postponed further unless severe complications arose or blood urea nitrogen exceeded 140 mg/dL. The study found no significant difference in the primary outcome of RRT-free days at 28 days between the delayed and more-delayed groups. However, a prespecified multivariable analysis revealed higher 60-day mortality in the more-delayed group. These findings suggest that extending the delay for RRT initiation does not confer additional benefits and may increase mortality risk in critically ill patients with severe AKI.