The influence of end-stage renal failure on the management of critically ill patients has been asked about in several SAQs:
The college's model answer was so good, that it would have been a waste not to reproduce it here.
Renal: Metabolic and Endocrine: Cardiovascular: Respiratory: Neurological: Polyneuropathy and myopathy |
Skin: Haematological: Gastrointestinal: Immunological: Pharmacological: Vascular access: |
To this, one might add a note regarding nutrition. A normal or slightly increased daily protein intake may be required to compensate for amino acid losses into the circuit, and for the hypercatabolic state of critical illness. In contrast, intermittent haemodialysis patients tend to benefit from low protein and low sodium diet so as to decrease their urea load.
LITFL take this answer, and build wonderfully upon it. Specifically, they quote an editorial by Szamosfalvi and Yee (2013), which is the single most useful published resource on this topic.
Issues specific to ESRD raised in this article include:
The all-cause in-ICU mortality of ESRD patients admitted to ICU seems to be over double that of patients without renal failure (11% vs 5%), though it is lower than the mortality of patients with acute renal failure (23%).
Clermont, Gilles, et al. "Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes." Kidney international 62.3 (2002): 986-996.
Szamosfalvi, Balazs, and Jerry Yee. "Considerations in the critically ill ESRD patient." Advances in chronic kidney disease 20.1 (2013): 102-109.
Arulkumaran, N., N. M. P. Annear, and M. Singer. "Patients with end-stage renal disease admitted to the intensive care unit: systematic review." British journal of anaesthesia 110.1 (2013): 13-20.
Thompson, Stephanie, and Neesh Pannu. "Renal replacement therapy in the end-stage renal disease patient with critical illness." Blood purification 34.2 (2012): 132-137.