So you need to start renal replacement therapy on your ICU patient?

Critical care physicians will increasingly encounter patients with both acute and chronic renal failure that will necessitate initiation or continuation of renal replacement therapy (RRT) whilst in the Intensive Care Unit (ICU). A clear understanding of the principles involved and outcome data associated with increasingly diverse area of RRT modalities is essential to attain optimal patient care. This article commences with a revision of the principles of dialysis and ultrafiltration, currently available modalities of RRT and indications for their commencement. Prevention strategies to avoid initiation of RRT are outlined, followed by a practical discussion of issues such as selection of a modality, dosing, filter selection, anticoagulation, vascular access, choice of fluids and other considerations, for when RRT must be commenced.