Choice of Renal Replacement Therapy and Role of Haemodialysis in the Intensive Care Unit

Renal replacement therapy (RRT) has become an established component of modern critical care. Approximately 60 70% of critically ill patients with severe acute kidney injury (AKI) are treated with RRT which represents ~5% of all intensive care unit (ICU) admissions (Ostermann & Chang, 2008; Uchino et al., 2005). Thirty years ago, intermittent haemodialysis for the critically ill patient with AKI was typically delivered three times weekly using dialysis machines without accurate volumetric control, acetate-based dialysate and unmodified cellulosic membrane dialysers. Peritoneal dialysis was performed with hard catheters and low dwell volumes. Since then, the types of RRT used in ICU and the available kits have advanced significantly. Despite its worldwide use, the practice of RRT is variable. The main reasons are differences in expertise of nursing and medical staff, local availability of machines and lack of robust clinical data to support one technique over another (Pannu et al., 2008). Several important aspects related to the management of RRT, including mode, optimal indications and timing are the focus of ongoing discussion and opposing views.