STARRT-AKI is one of the largest randomised trials addressing when to start renal-replacement therapy in severe acute kidney injury. More than 3,000 critically ill patients were assigned to an accelerated strategy, in which dialysis was started soon after eligibility, or a standard strategy that discouraged renal replacement unless conventional indications developed or kidney injury persisted. Ninety-day mortality was essentially identical between the two groups. Almost all patients assigned to accelerated therapy received renal replacement, while substantially fewer in the standard group required it. Among survivors, ongoing dialysis dependence was more common after the accelerated strategy, and adverse events were also more frequent. The study therefore provides strong evidence against routine accelerated dialysis in patients with severe AKI who do not yet have urgent indications. For practice, this means clinicians can often allow time for spontaneous renal recovery while closely monitoring potassium, acid-base status, fluid balance, uraemic symptoms and overall trajectory. STARRT-AKI is particularly useful because it was international and included a broad ICU population, strengthening its applicability. The trial also highlights a common principle in critical care: earlier intervention is not automatically better. When an invasive supportive therapy carries its own risks and many patients may recover without it, the safest strategy may be to wait until the balance of benefit and harm clearly favours treatment.