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This interesting letter published in the recent publication of the journal Critical Care by Nierhaus et al. Critical Care (2018) 22:201, highlights some important and interesting findings with regards to biomarkers and how they can predict the need for renal replacement therapy in critically ill patients.

What is more interesting is how eloquently they referred to the fact that renal dysfunction represents likely one of the facets that forecast the progression towards multiple organ dysfunction syndrome. This very much is what we see in the intensive care unit where renal replacement therapy if used, only addresses one aspect of the ensuing multiorgan dysfunction in patients with septic shock. It also is an important educational point when discussing with families because renal replacement therapy only offers 1 modality of correcting the complex multiorgan dysfunction that often on its own is not able to reverse the patient’s trajectory.

In this letter, they discuss a secondary analysis of the SISPCT trial, which interestingly shows that renal replacement therapy was initiated and approximately 30% of patients with severe sepsis and septic shock within the first 21 days. Furthermore the mortality in this patient group is striking approximately at 50% on average. Even though the article discusses the potential role for MR-proADM as a biomarker, these findings and overall percentages are sobering due to the fact that they reflect how challenging this patient population is and how renal replacement therapy not only can be helpful but also unfortunately likely heralds multi-organ dysfunction and comes with an unwelcome companion, that being a high mortality risk.

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