Dialysis patients account for 1–9% of all intensive care unit (ICU) admissions. As a result of the increasing prevalence of patients with end-stage renal disease (ESRD) and the changing demographics of this population, the number of dialysis patients requiring hospitalization and ICU support is expected to increase. Critically ill ESRD patients have more comorbidity and higher severity of illness than the general population resulting in higher ICU and in-hospital mortality rates. ESRD patients have been excluded from trials evaluating renal replacement therapy in the ICU, therefore little information is available about the optimal management of renal replacement therapy for dialysis patients in this setting. This review focuses on the epidemiology of chronic dialysis patients admitted to the ICU and discusses an approach to providing renal replacement therapy for critically ill patients with ESRD.

Keywords:
Dialysis, Intensive care unit, Critical illness
1.
USRDS 2010 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda , 2010.
2.
Hutchinson CA, Stevens PE, Harrison DA, Lipkin GW: Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC case mix programme database. Crit Care 2007;11:R50.
3.
Strijack B, Mojica J, Sood M, et al: Outcomes of chronic dialysis patients admitted to the intensive care unit. J Am Soc Nephrol 2009;20:2441–2447.
4.
Manhes G, Heng AE, Aublet-Cuvelier B, Gazuy N, Deteix P, Souweine B: Clinical features and outcome of chronic dialysis patients admitted to an intensive care unit. Nephrol Dial Transplant 2005;20:1127–1133.
5.
Dara SI, Afessa B, Bajwa AA, Albright RC: Outcome of patients with end-stage renal disease admitted to the intensive care unit. Mayo Clin Proc 2004;79:1385–1390.
6.
Clermont G, Acker CG, Angus DC, Sirio CA, Pinsky MR, Johnson JP: Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int 2002;62:986–996.
7.
Uchino S, Morimatsu H, Bellomo R, Silvester W, Cole L: End-stage renal failure patients requiring renal replacement therapy in the intensive care unit: incidence, clinical features, and outcome. Blood Purif 2003;21:170–175.
8.
Senthuran S, Bandeshe H, Ranganathan D, Boots R: Outcomes for dialysis patients with end-stage renal failure admitted to an intensive care unit or high dependency unit. Med J Aust 2008;188:292–295.
9.
Bell M, Granath F, Schon S, Lofberg E, Ekbom A, Martling CR: End-stage renal disease patients on renal replacement therapy in the intensive care unit: short- and long-term outcome. Crit Care Med 2008;36:2773–2778.
10.
Juneja D, Prabhu MV, Gopal PB, Mohan S, Sridhar G, Nayak KS: Outcome of patients with end stage renal disease admitted to an intensive care unit in India. Ren Fail 2010;32:69–73.
11.
Herzog CA, Li S, Weinhandl ED, Strief JW, Collins AJ, Gilbertson DT: Survival of dialysis patients after cardiac arrest and the impact of implantable cardioverter defibrillators. Kidney Int 2005;68:818–825.
12.
Paoletti E, Specchia C, Di Maio G, et al: The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10-year survey. Nephrol Dial Transplant 2004;19:1829–1834.
13.
Sakhuja R, Keebler M, Lai TS, McLaughlin Gavin C, Thakur R, Bhatt DL: Meta-analysis of mortality in dialysis patients with an implantable cardioverter defibrillator. Am J Cardiol 2009;103:735–741.
14.
Wang AY, Lam CW, Chan IH, Wang M, Lui SF, Sanderson JE: Sudden cardiac death in end-stage renal disease patients: a 5-year prospective analysis. Hypertension 2010;56:210–216.
15.
Bleyer AJ, Hartman J, Brannon PC, Reeves-Daniel A, Satko SG, Russell G: Characteristics of sudden death in hemodialysis patients. Kidney Int 2006;69:2268–2273.
16.
Zoccali C, Mallamaci F, Parlongo S, et al: Plasma norepinephrine predicts survival and incident cardiovascular events in patients with end-stage renal disease. Circulation 2002;105:1354–1359.
17.
Sood MM, Miller L, Komenda P, et al: Long-term outcomes of end-stage renal disease patients admitted to the ICU. Nephrol Dial Transplant 2011;26:2965–2970.
18.
Ostermann M, Chang R: Renal failure in the intensive care unit: acute kidney injury compared to end-stage renal failure. Crit Care 2008;12:432.
19.
Sood MM, Roberts D, Komenda P, et al: End-stage renal disease status and critical illness in the elderly. Clin J Am Soc Nephrol 2011;6:613–619.
20.
Chapman RJ, Templeton M, Ashworth S, Broomhead R, McLean A, Brett SJ: Long-term survival of chronic dialysis patients following survival from an episode of multiple-organ failure. Crit Care 2009;13:R65.
21.
Bagshaw SM, Mortis G, Doig CJ, Godinez-Luna T, Fick GH, Laupland KB: One-year mortality in critically ill patients by severity of kidney dysfunction: a population-based assessment. Am J Kidney Dis 2006;48:402–409.
22.
Rabindranath K, Adams J, Macleod AM, Muirhead N: Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev 2007:CD003773.
23.
Paganini EP, Sandy D, Moreno L, Kozlowski L, Sakai K: The effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study. Nephrol Dial Transplant 1996;11(suppl 8):32–37.
24.
Kielstein JT, Kretschmer U, Ernst T, et al: Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis 2004;43:342–349.
25.
Marshall MR, Creamer JM, Foster M, et al: Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries. Nephrol Dial Transplant 2011;26:2169–2175.
26.
Fieghen HE, Friedrich JO, Burns KE, et al: The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury. BMC Nephrol 2010;11:32.
27.
Eknoyan G, Beck GJ, Cheung AK, et al: Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019.
28.
Palevsky PM, Zhang JH, O’Connor TZ, et al: Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 2008;359:7–20.
29.
Bellomo R, Cass A, Cole L, et al: Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009;361:1627–1638.
30.
Clinical Practice Guidelines for Hemodialysis Adequacy, Update 2006. Am J Kidney Dis 2006;48(suppl 1):S2–S90.
31.
Canaud B, Desmeules S, Klouche K, Leray-Moragues H, Beraud JJ: Vascular access for dialysis in the intensive care unit. Best Pract Res Clin Anaesthesiol 2004;18:159–174.
32.
Parienti JJ, Thirion M, Megarbane B, et al: Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 2008;299:2413–2422.
33.
Del Vecchio L, Pozzoni P, Andrulli S, Locatelli F: Inflammation and resistance to treatment with recombinant human erythropoietin. J Ren Nutr 2005;15:137–141.
34.
Zarychanski R, Turgeon AF, McIntyre L, Fergusson DA: Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials. CMAJ 2007;177:725–734.
35.
Juneja D, Prabhu MV, Gopal PB, Mohan S, Sridhar G, Nayak KS: Outcome of patients with end stage renal disease admitted to an intensive care unit in India. Ren Fail 2010;32:69–73.
36.
Rocha E, Soares M, Valente C, et al: Outcomes of critically ill patients with acute kidney injury and end-stage renal disease requiring renal replacement therapy: a case-control study. Nephrol Dial Transplant 2009;24:1925–1930.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.