Dialysis

Renal replacement therapy (RRT) replaces the function of the failing kidney, resulting in multiple physiologic benefits: removes excess fluid, corrects metabolic derangements, removes uremic toxins, corrects electrolyte and acid–base abnormalities, and can be used to treat toxic ingestions of certain drugs. There are three main modalities of artificial renal support in the ICU setting: intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), and peritoneal dialysis. There are different guidelines giving recommendations for the timing of initiation of RRT in the ICU. The most common complications of RRT are hypotension and cardiac arrhythmia. Hypotension tends to be more problematic with IHD than with continuous forms of RRT. For this reason CRRT is preferred when patients are hemodynamically unstable.