Management of Chronic Kidney Disease and End-Stage Kidney Disease Patients in the Intensive Care Unit

Patients with chronic kidney disease (CKD) are at high risk for critical illness and for admission into an intensive care unit (ICU). "Critically ill CKD patients" frequently develop an acute worsening of renal function (i.e., acute-on-chronic, AoC) that contributes to a long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to manage adequately the multiorgan damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction during their critical illness. The aim of this chapter is to describe (1) the pathophysiologic mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice versa, for AoC patients who develop ESKD.