Predicting and managing complications of renal replacement therapy in the critically ill

Renal replacement therapy (RRT) remains associated with a significant risk of serious complications, and critically ill patients requiring RRT continue to manifest particularly poor overall survival rates. These poor outcomes persist despite improvements in the modalities employed as well as an enhanced understanding of the effects of the extracorporeal circuit, anticoagulation, treatment doses, fluid replacement and dialysis membrane. More recently, there has been an emerging appreciation that intermittent RRT (in the chronic maintenance haemodialysis setting) is capable of generating sufficient circulatory stress to propagate additional widespread end-organ injury. The mitigation of this plethora of risks by the correct identification of complications, targeting of therapy refinements and prediction, whilst problems still remain occult, is desirable and becoming increasingly possible in the pursuit of improved outcomes in this high-mortality therapeutic field.