<![CDATA[Background: Stage 5 CKD patients frequently present with cardiorenal emergencies in the form of acute pulmonary edema and severe metabolic acidosis, requiring rapid stabilization and emergency Kidney Replacement Therapy (KRT). Methods: An observational case report of a 72-year-old female patient admitted to the intensive care unit (ICU) with chief complaints of acute dyspnea. Data were collected through history taking, physical examination, and diagnostic workups. Results: The patient was diagnosed with stage 5 CKD, acute pulmonary edema, and metabolic acidosis. Clinical findings revealed tachypnea, tachycardia, altered mental status, decreased oxygen saturation, and lung auscultation indicating fluid overload. Management included oxygenation, administration of diuretics, nitroglycerin, electrolyte correction, and acid-base balancing. Hemodialysis was performed via a central venous catheter for 2.5 hours using a low-flow rate, bicarbonate dialysate, and controlled ultrafiltration. Conclusion: The management of stage 5 CKD patients in the ICU with critical cardiorenal complications relies on the synergy between cardiorespiratory stabilization and the initiation of Kidney Replacement Therapy. The use of hemodialysis has proven effective in reversing respiratory failure, pulmonary edema, and severe metabolic acidosis without precipitating intracranial complications or further hemodynamic instability.]]>
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