Critical Care Nephrology: A Multidisciplinary Approach

Abstract

Acute renal failure is a common complication in critically ill patients, affecting some 25% of intensive care unit (ICU) admissions, and is associated with high mortality rates of around 40-50%. Acute renal failure in the ICU frequently occurs as part of multiple organ failure (MOF). We reviewed the pertinent medical literature related to the occurrence of acute renal failure in the ICU and its association with other organ failures. We also reviewed the literature related to different patient management strategies, notably the differences between 'closed' and 'open' ICU formats. The increasingly common association of acute renal failure with other organ failures, in the context of a more generalized MOF, has important implications on patient care, moving management away from the realm of nephrologists and towards a more multidisciplinary approach. Closed ICU formats with intensivist-led care, supported by specialist consultation, have been shown to be associated with improved ICU outcomes. ICU patients with acute renal failure should be managed using a multidisciplinary team approach led by an intensivist. Good collaboration and communication between intensivists and renal and other specialists is essential to insure the best possible care for ICU patients with renal disease.