Acute renal failure (ARF) with need for renal replacement therapy (RRT) is a frequent condition in the intensive care unit (ICU), with a reported incidence between 10 and 30%[1]. Although there is indirect evidence that the general outcome of these patients has improved over the last two decades, the mortality rate is still unacceptably high [2, 3]. Further research to improve their management is thus warranted. Because of the widespread availability of venovenous hemo (dia) filtration as continuous renal replacement technique (CRRT), treatment of ARF in the ICU became also technically feasible for the intensive care specialist, and the debate whether CRRT or intermittent hemodialysis (IHD) is the dialytic treatment of choice, is often reduced to the question whether or not the nephrologist is in charge of ICU-related ARF [4]. This is an unfortunate evolution, as both techniques have their advantages and disadvantages. The optimal use of all available techniques and the selection of the modality is, in our view, the responsibility of the nephrologist, who has to collaborate closely with the ICU specialist, to establish an optimal dialytic and nondialytic management of the critically ill patient.

In the present contribution, we will focus on the specific advantages and disadvantages of IHD in the ICU setting. The topics that will be discussed include the equipment, with focus on particular characteristics compared to chronic hemodialysis, special modifications of the renal replacement technique and anticoagulation problems.