Critical care issues in the patient with chronic renal failure

There are currently approximately 250,000 patients in the United States on maintenance dialysis [78], and it is estimated that an additional 6.2 million Americans have chronic renal impairment as defined by a serum creatinine level of 1.5 mg/dL or greater [46]. Hospitalizations in these patients are frequent because of multiple comorbid conditions and complications of renal failure and dialysis itself. According to the US Renal Data System (USRDS), chronic-dialysis patients are hospitalized for an average of 14.1 days per year [78]. A substantial proportion of these hospitalizations include a period in the intensive care unit (ICU). Although critical care of patients with chronic renal failure in most respects does not differ in most respects from that of patients with normal renal function, there are several issues that require special attention. This article reviews aspects of critical care that are unique to patients with chronic renal failure with an emphasis on patients requiring maintenance dialysis.