Renal replacement therapy in the intensive care unit

Introduction Acute renal failure is a frequent complication in critically ill patients and carries a mortality of 50 to 70%.[1] The traditionally held belief has been that kidney failure does not kill on its own as long as complications such as hyperkalaemia, acidosis and volume overload are prevented. There is evidence to suggest that this may not always be the case. We know today that acute renal failure in the critical care setting may be an independent predictor of mortality.[2,3] The management of acute renal failure in the setting of multi-organ failure is considerably different from that of renal failure as a single organ failure (e.g.; due to nephrotoxic drugs). The traditional criteria for initiating dialysis only in the face of diuretic resistant volume overload, metabolic acidosis or hyperkalaemia are largely unsuited to the management of acute renal failure in modern intensive care practice. There is strong evidence to suggest that early and more intense renal