ABSTRACT
Acute renal failure (ARF) is broadly defined as deterioration of renal function over days to weeks, a common occurrence in intensive care unit (ICU) patients; incidence and mortality estimates vary according to ARF definition and associated morbidities.1-3 The mortality of ARF is 50-80% in ICU populations, and has not declined significantly since the initial marked benefit of acute dialysis therapy, despite numerous advances in renal replacement technologies and critical care over several decades.4 Although multiple system organ failure (MSOF) and other comorbidities contribute to its high mortality rate, ARF independently increases morbidity and mortality.5-8 The mechanisms by which ARF contributes to nonrenal organ dysfunction and death are incompletely understood. Emerging data suggest that isolated renal ischemia-reperfusion injury causes injury and dysfunction of distant organs in experimental ARF.9-11 Apart from obviously lethal ARF sequelae such as severe hyperkalemia, the identities and precise effects of ‘uremic’ toxins have not been identified, particularly in ARF. Accordingly, it is likely that renal replacement therapy in its current form is only a partial solution to the multisystem problems caused by ARF.
