Renal replacement therapy in liver transplant–ineligible patients

The decision to initiate renal replacement therapy in patients who are ineligible for liver transplantation can be challenging. Careful patient selection is required to identify those who may benefit from early renal replacement therapy as a pathway toward liver recovery or as a palliative plan of care. Emerging literature suggests that the etiology of kidney injury should play less of a role in clinical decision-making. Decisions around renal replacement therapy are often influenced by medical, ethical, and end-of-life factors and should be made in conjunction with patients and their caregivers.