The process of tackling all of the issues related to acute renal failure began with the initial focus on its dialytic management (Acute Dialysis Quality Initiative I: the New York conference), because this required urgent attention. However, it was clear from the start that the entire issue of acute renal failure, including its definition, epidemiology inside and outside of the intensive care unit, the animal models used to develop new interventions, the issue of fluid therapy, the application of information technology to its care, the choice of appropriate physiologic goals for phase I and phase II studies, and the need to define appropriate clinical goals for large, randomized, clinical trials, required systematic attention. Accordingly, the second Acute Dialysis Quality Initiative conference in Vicenza, Italy, was organized, and its goals and rationale are presented in this report.