Acute renal failure (ARF) is a major cause of morbidity and mortality, particularly in the hospital setting. Despite improvements in renal replacement therapy (RRT) techniques during the last several decades, the mortality rate associated with ARF in critically ill patients remains above 50 percent. (See "Renal and patient outcomes after acute tubular necrosis".)
RRT is ideally initiated in the acute setting prior to the dangerous accumulation of extravascular volume and/or uremic toxins that can result in further multi-organ damage and failure. Once the decision to initiate RRT has been made, the specific modality of dialytic support must be chosen. This consists of peritoneal dialysis, intermittent hemodialysis and its variations (eg, hemofiltration), and continuous renal replacement therapy. Once the selection is made, the acute dialysis prescription can be determined.
An acute hemodialysis treatment is defined as a hemodialysis session specifically performed for ARF (also known as acute kidney injury [AKI]) or in the setting of a hospitalized end stage renal disease (ESRD) patient. The choice of specific dialysis modality, particularly the choice between continuous or intermittent dialysis, is discussed separately. (See "Continuous renal replacement therapy in acute kidney injury (acute renal failure)".)
The various components of the acute hemodialysis prescription will be described here. The use of peritoneal dialysis in ARF is discussed separately (see "Use of peritoneal dialysis for the treatment of acute kidney injury (acute renal failure)").
The urgent indications for RRT in patients with ARF generally include volume overload refractory to diuretics, hyperkalemia, metabolic acidosis, uremia, and toxic overdose of a dialyzable drug. In an attempt to minimize morbidity, dialysis should be started prior to the onset of overt complications of renal failure, whenever possible. This is discussed in detail separately. (See "Renal replacement therapy (dialysis) in acute kidney injury (acute renal failure) in adults: Indications, timing, and dialysis dose", section on 'Indications for and timing of initiation of dialysis'.)