The U.S. Army has demonstrated that acute renal failure (ARF) could be treated successfully with dialysis during war since the early 1950s. Recent downsizing and lack of ARF patients during recent deployments may reduce the urgency to invest in the equipment modernization, personnel, and training necessary to maintain deployment dialysis capability. New dialysis equipment must be developed and purchased to replace the current Army deployable dialysis equipment that will be obsolete soon. The objective of this paper is to review ARF and dialysis during past American wars, the Armenian earthquake, and recent field training exercises to derive lessons for policy planners, clinicians, and logisticians for future deployments. Methods included medical literature search and describing the experiences of current Army personnel. The advantages and disadvantages of several commercially available dialysis systems are discussed in the context of deployment environment and policy. Recommendations for equipment and training are proposed to maintain deployment dialysis capability.