Chronic Kidney Disease in the Intensive Care Unit

The incidence and prevalence of chronic kidney disease (CKD) and end-stage renal disease are increasing, and these patients have a higher risk of developing critical illness and being admitted to the intensive care unit (ICU) compared to the general population. The higher prevalence of comorbid disease puts this population at higher risk for worse short- and long-term outcomes following ICU admission compared to the general population, although short-term mortality seems to be determined largely by the acute illness severity rather than CKD status per se. The pathophysiologic changes accompanying CKD present unique challenges to the management of acute critical illness most notably volume and metabolic homeostasis and drug dosing adjustment. CKD is an important risk factor for the development of acute kidney injury (AKI) complicating critical illness and can predispose to further accelerated decline in kidney function among ICU survivors. Renal replacement therapy (RRT) support is frequently used in ICU settings, and continuous renal replacement therapy modality remains the most commonly used among critically ill patients.