ABSTRACT
Intermittent hemodialysis (IHD) has been a clinical reality for critically ill acute renal failure (ARF) patients for half a century. The fundamental therapeutic objectives underlying these early efforts continue to form the basis for modern practice.1 Over this period, there have been refinements in the technology of vascular access, hemodialyzers, and supporting machinery as well as a clearer understanding of patient response to IHD. As a result, the application of IHD treatments has become safer and easier. Although the mortality of critically ill ARF patients remains high, there is evidence that outcomes are gradually improving despite a higher degree of prevalent illness severity.2,3
IHD is overall the most common renal replacement therapy for critically ill ARF patients.4 Practice patterns are determined mostly by logistic concerns such as cost and access to technology, and follow predictable geographic patterns that can be in most part related to reimbursement patterns and clinical responsibility for the respective modalities. In the United States, IHD is far more commonly utilized than continuous renal replacement therapy (CRRT), and managed by nephrologists.5 In Australia, the converse is true.6 European practice patterns vary by region, and both CRRT and IHD on balance appear equally common, with responsibility for therapy equally split between intensivists and nephrologists.7
