RT Book, Section A1 Coritsidis, George A1 Bhatti, Saad A2 Oropello, John M. A2 Pastores, Stephen M. A2 Kvetan, Vladimir SR Print(0) ID 1136414759 T1 Renal Replacement Therapy T2 Critical Care YR 1 FD 1 PB McGraw-Hill Education PP New York, NY SN 9780071820813 LK accessmedicine.mhmedical.com/content.aspx?aid=1136414759 RD 2024/10/07 AB KEY POINTSRenal replacement therapy (RRT) is one of the most expensive interventions used in an already cost burdensome intensive care unit (ICU) setting. Prescribing RRT in the critically ill is complex and ideally should involve clear communication between nephrologist and intensivist.RRT modalities include peritoneal dialysis, intermittent hemodialysis, continuous renal replacement therapies, and sustained low-efficiency daily dialysis.These modalities utilize 2 transport mechanisms in providing renal replacement: diffusion and convection. These forces result in solute clearance and plasma water removal or ultrafiltration (UF).RRT is initiated early in patients whose renal function is not expected to quickly improve due to severity of illness and is unresponsive to resuscitation: multiorgan failure, high fractional excretion of sodium (FENa), rising azotemia (without plateau of urea or creatinine levels), and oliguria all suggestive of acute tubular necrosis (ATN).At present, randomized trials and meta-analyses, do not support a mortality benefit for one modality over another. However, a gradual clearance rate may be wise in hemodynamic instability, acute coronary syndromes, elevated intracranial pressures (ICPs), or hypo/hypernatremia.