Introduction

• Acute renal failure (ARF) in the critically ill, almost always, develops as part of multiple organ dysfunction (or failure) syndrome.

• ARF in the critically ill has high mortality.

• Understanding renal physiology and pathophysiology of ARF in the critically ill (especially those with sepsis-associated ARF or SAARF) provides logical guidelines for prevention and/or management of patients at risk.

• To date there are no proven pharmacological therapies that “prevent” ARF.

• Our understanding of ARF in the critically ill is far from complete.

• ARF in the critically ill is distinctly different from “medical” ARF; and management of these patients is often challenging.

• Critically ill patients with ARF have higher mortality than a similar cohort of patients without ARF.

Incidence and definition

• ARF in the critically ill is not properly defined.

• In the literature, definitions for ARF, populations studied and timing of interventions seem to be different in different studies.

• This creates problems in interpreting the available literature.

• Besides that, defining points at which interventions like renal replacement therapy (RRT) should begin or stop also becomes difficult.

• Lack of definition also means that it is difficult to estimate accurate incidence of this disease in our intensive care unit (ICU) patients.

• In the literature, the incidence of ARF is quoted as 0.14% (community acquired or “medical” ARF) to 33% in the critically ill. In some recent studies, ARF complicating critical illness has been estimated to be of the order of 4–8%. Based on unpublished data (1997–2001), the incidence of ARF in author's ICU is about 15–20% (a tertiary referral unit).

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