ABSTRACT
Acute renal failure (ARF) with need for renal replacement (RRT) in the intensive care unit (ICU) is a complex and devastating condition, with a reported mortality rate as high as 50-80%.1,2 Although gross mortality rates have only declined slightly over the past decades, it is accepted that survival is increased by improvement in overall care, since the comorbidity of patients and the severity of the underlying diseases treated have also dramatically increased.3,4 Although ARF by itself contributes to the overall mortality of critically ill patients, ARF mostly develops as a consequence of other underlying diseases, and patients often do not die of ARF but from these underlying conditions. Thus, the idea that by inventing ‘the perfect RRT machine’, no more patients with ICUrelated ARF will die, will of course remain an illusion. Because renal function mostly recovers if the ARF patient survives, RRT in ARF should thus be seen as a bridging therapy that allows the patient to survive while the native kidneys recover. The main objective of RRT is to avoid additional harm to the patient as much as possible during the spontaneous recovery of renal function.
