Primary prevention of acute renal failure in the critically ill

PURPOSE OF REVIEW: Acute renal failure is both common and highly lethal in the intensive care unit, with hospital mortality rates in excess of 50%. To date, no therapy apart from renal replacement therapy has been shown to improve survival or enhance recover. Thus, efforts to prevent acute renal failure are eagerly sought. RECENT FINDINGS: Fluids and avoiding hypotension and nephrotoxins appear to be the most effective strategies to prevent acute renal failure. N-acetylcysteine has been shown to prevent the increase in serum creatinine in high risk patients given intravenous radiocontrast agents, although there is some evidence that N-acetylcysteine may reduce serum creatinine without increasing glomerular filtration. SUMMARY: The best evidence suggests that nonpharmacologic strategies are more effective than drugs in reducing the risk of acute renal failure. Evidence also exists that strategies that improve survival in critically ill patients also reduce the incidence of organ failure, including acute renal failure.