Management of acute renal failure on the intensive care unit.

Acute renal failure (ARF) complicates up to 5% of all hospital admissions, and as many as 35% of patients admitted to an intensive care unit (ICU) receive renal replacement therapy (RRT)1. These figures will vary with the case mix of the unit, the threshold at which RRT is instituted and the definition of ARF used. The lack of a consensus definition of ARF remains a major problem in interpreting studies of its epidemiology, management and outcome. In ICU, ARF nearly always occurs as part of multiple organ failure (MOF) for which mortality exceeds 60%, rising to over 90% if four or more organs fail. Early diagnosis and the appropriate monitoring and timing of intervention will prevent the fatal metabolic sequelae of ARF. This article reviews the causes and management of ARF in the ICU.