The authors review treatment of acute renal failure in critically ill patients, indications for intermittent hemodialysis and continuous renal replacement therapy, and the use of other variations of this therapy currently under investigation.

Acute renal failure (ARF) is a common complication in critically ill adult patients in critical care units. ARF is defined as a sudden decline or cessation of renal function. Characteristics include inability of the kidneys to excrete wastes and maintain fluid, electrolyte, and acid-base balance.1,2 Despite advances in treatment, data from the past several decades continue to indicate that ARF still is associated with high mortality rates, ranging from 25% to 90%.3,4 Factors that may influence the rates include the increasing age of patients and the existence of comorbid conditions (eg, diabetes, preexisting renal disease, vascular disease).1 

Historically, the treatment of ARF has been supportive. The primary focus of intermittent...

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