It's hard to get going, if you don't know where to start. The same applies to the ICU, where it's never clear when to initiate hemodialysis (HD). Researchers randomized over 600 patients to early HD at the time of randomization versus delayed HD following onset of a strict dialysis indication. There was no mortality difference between the two groups, but the delayed HD group experienced fewer line-associated infections and earlier recovery of kidney function. Note that only 30% of the study's patients were on continuous veno-venous hemofiltration (CVVH), which has become the standard of care in many ICUs.