ABSTRACT
End-stage renal disease (ESRD) is becoming a common condition. Over 275 000 patients currently receive dialysis care in the United States as of December 31, 2000, whereas over 103 800 patients have functioning renal allografts.1 Hemodialysis patients have a very high rate of general hospitalization (approximately 2000 admissions per 1000 patient-years at risk), as do renal transplant patients. Although the rates of hospital admission for transplant patients are significantly lower (approximately 800 admissions per 1000 patientyears at risk),1 this rate still far exceeds the general risk for hospitalization for the general population.1(p24) Congestive heart failure and infectious complications are the top reasons for hospitalization admissions among all ESRD patients,1(p18) whereas complications resulting from vascular access lead admission rates for patients 67 years old or older in the immediate month following initiation of renal replacement therapy.1(p18) The average admission duration for a patient with ESRD on dialysis is approximately 14 days, with an average of two admissions per year.1 These admissions have high cost implications for our society. The total cost of hospitalization of the ESRD population has increased from over US$3 billion to over US$4.2 billion over the past 5 years.1(p27)
Specific rates of intensive care unit (ICU) admission are not available for the ESRD populations in the United States, Europe, or for other regions. In fact, little published data exist in regard to etiology of ICU admissions, rates of ICU admissions, outcomes, or general utility of these activities to our society and the ESRD population as a whole. These issues not withstanding, all practitioners in the ICU environment will deal quite commonly with ESRD patients. This chapter discusses the salient issues with respect to the clinical management of the chronic hemodialysis and renal transplant patient who requires ICU care.
