Key messages

• Maintenance of sufficient intravascular volume, normal or high normal cardiac output, and an adequate mean arterial pressure (typically > 80 mmHg) are important goals of hemodynamic resuscitation in patients at risk of acute renal failure.

• There is currently no convincing evidence that specific drugs, such as dopamine, mannitol, or loop diuretics, exert a clinically important level of renal protection in patients at risk of renal failure.

• Patients with acute renal failure should be treated like all other critically ill patients, and physiological and biochemical homeostasis, as well as adequate nutrition, should be diligently pursued.

• Despite the lack of randomized controlled trials to provide convincing and clear support for their use, continuous renal replacement therapies have major practical and physiological advantages over standard intermittent hemodialysis in critically ill patients and are probably the preferred approach to renal replacement therapy in the intensive care unit.

• Maintenance of good resuscitation, avoidance of hypotension, adequate nutrition, prompt treatment of sepsis, use of biocompatible dialysis membranes, and attention to physiological and biochemical details are important clinical means of preventing further renal injury in established renal failure.

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