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Renal Replacement Therapy

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Surgery

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Abstract

Acute renal failure (ARF) is a commonly anticipated diagnosis in critically ill patients in the intensive care unit (ICU). Its actual frequency varies from less than 10% to approximately 25% in different series including different patient demographics and definitions of ARF.1–5 The elevations in serum creatinine and urea nitrogen concentrations observed in a majority of these patients (more than 90%) are caused by renal hypoperfusion and related parenchymal dysfunction, the latter referred to as acute tubular necrosis (ATN)3,6 (Tables 33.1, 33.2). Between one-third and one-half of the observed ATN occurs during infection/sepsis, with the rest related to medical-surgical conditions, including hypotension and toxin exposure.3,6 ARF is typically accompanied by a number of comorbidities [i.e., respiratory failure (67%), heart failure (48%), and liver failure (31%)].7 In many series, more than one-half of the patients who develop ARF in the ICU require some form of renal replacement therapy (RRT).3,6,7

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Authors and Affiliations

  1. Departments of Clinical Medicine and Surgery, Weill Cornell Medical College, New York, NY, USA

    John C. L. Wang MD, PhD (Professor, Vice President for Out-Patient Services, Director and Co-Director), Roxana M. Bologa MD (Assistant Professor and Co-Director) & Stuart D. Saal MD (Professor, Vice President for Hospital Affairs, Medical Director and Co-Director)

  2. Jack J. Dreyfus Clinic of Rogosin Kidney Center, The Rogosin Institute, New York, NY, USA

    John C. L. Wang MD, PhD (Professor, Vice President for Out-Patient Services, Director and Co-Director)

  3. Adoptive Immunotherapy Program, The Rogosin Institute, New York, NY, USA

    John C. L. Wang MD, PhD (Professor, Vice President for Out-Patient Services, Director and Co-Director)

  4. Nephrology, The Rogosin Institute, New York, NY, USA

    John C. L. Wang MD, PhD (Professor, Vice President for Out-Patient Services, Director and Co-Director)

  5. Renal Consultation Service, The Rogosin Institute, New York, NY, USA

    John C. L. Wang MD, PhD (Professor, Vice President for Out-Patient Services, Director and Co-Director) & Stuart D. Saal MD (Professor, Vice President for Hospital Affairs, Medical Director and Co-Director)

  6. Peritoneal Dialysis, The Rogosin Institute, New York, NY, USA

    Roxana M. Bologa MD (Assistant Professor and Co-Director)

  7. Transplantation Program, The Rogosin Institute, New York, NY, USA

    Stuart D. Saal MD (Professor, Vice President for Hospital Affairs, Medical Director and Co-Director)

  8. Apheresis, The Rogosin Institute, New York, NY, USA

    Stuart D. Saal MD (Professor, Vice President for Hospital Affairs, Medical Director and Co-Director)

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  1. John C. L. Wang MD, PhD
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  3. Stuart D. Saal MD
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Editor information

Editors and Affiliations

  1. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    Jeffrey A. Norton MD, FACS (Robert L. and Mary Ellenburg Professor, Chief) (Robert L. and Mary Ellenburg Professor, Chief)

  2. Divisions of Surgical Oncology and General Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    Jeffrey A. Norton MD, FACS (Robert L. and Mary Ellenburg Professor, Chief) (Robert L. and Mary Ellenburg Professor, Chief)

  3. Departments of Surgery and Public Health, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA

    Philip S. Barie MD, MBA, FCCM, FACS (Professor, Chief) (Professor, Chief)

  4. Division of Critical Care and Trauma, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA

    Philip S. Barie MD, MBA, FCCM, FACS (Professor, Chief) (Professor, Chief)

  5. Departments of Surgery and Immunology, Duke University Medical Center, Durham, NC, USA

    R. Randal Bollinger MD, PhD, FACS (Professor) (Professor)

  6. Division of Surgical Oncology, Department of Surgery, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA

    Alfred E. Chang MD, FACS (Chief, Hugh Cabot Professor of Surgery) (Chief, Hugh Cabot Professor of Surgery)

  7. Department of Surgery, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA

    Stephen F. Lowry MD, MBA, FACS (Professor and Chairman) (Professor and Chairman)

  8. Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Stephen F. Lowry MD, MBA, FACS (Professor and Chairman) (Professor and Chairman)

  9. Department of Surgery, The University of Utah, Salt Lake City, UT, USA

    Sean J. Mulvihill MD, FACS (Professor and Chair, Senior Director of Clinical Affairs) (Professor and Chair, Senior Director of Clinical Affairs)

  10. Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA

    Sean J. Mulvihill MD, FACS (Professor and Chair, Senior Director of Clinical Affairs) (Professor and Chair, Senior Director of Clinical Affairs)

  11. Departments of Cardiothoracic Surgery and Surgery, New York University Medical Center, New York, NY, USA

    Harvey I. Pass MD, FACS (Professor) (Professor)

  12. Radiology, and Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA

    Robert W. Thompson MD, FACS (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research) (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research)

  13. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Robert W. Thompson MD, FACS (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research) (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research)

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Wang, J.C.L., Bologa, R.M., Saal, S.D. (2008). Renal Replacement Therapy. In: Norton, J.A., et al. Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68113-9_33

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