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- Title
Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy.
- Authors
Mark R. Marshall; Tianmin Ma; David Galler; Alan Patrick Nigel Rankin; Anthony Brendan Williams
- Abstract
Background. Sustained low-efficiency daily dialysis (SLEDD) is an increasingly popular renal replacement therapy for intensive care unit (ICU) patients. SLEDD has been previously reported to provide good solute control and haemodynamic stability. However, continuous renal replacement therapy (CRRT) is considered superior by many ICU practitioners, due first to the large amounts of convective clearance achieved and second to the ability to deliver treatment independently of nephrology services. We report on a program of sustained low-efficiency daily diafiltration (SLEDD-f) delivered autonomously by ICU nursing personnel, and benchmark solute clearance data with recently published reports that have provided doseoutcome relationships for renal replacement therapy in this population.Methods. SLEDD-f treatments were delivered using countercurrent dialysate flow at 200?ml/min and on-line haemofiltration at 100?ml/min for 8?h on a daily or at least alternate day basis. All aspects of SLEDD-f were managed by ICU nursing personnel. Clinical parameters, patient outcomes and solute levels were monitored. Kt/V, corrected equivalent renal urea clearance (EKRc) and theoretical Kt/VB12 were calculated.Results. Fifty-six SLEDD-f treatments in 24 critically ill acute renal failure patients were studied. There were no episodes of intradialytic hypotension or other complications. Observed hospital mortality was 46%, not significantly different from the expected mortality as determined from the APACHE II illness severity scoring system. Electrolyte control was excellent. Kt/V per completed treatment was 1.430.28 (0.962.0). Kt/VB12 per completed treatment was 1.020.21 (0.61.38). EKRc for patients was 35.76.4?ml/min (25.048.2).Conclusion. SLEDD-f provides stable renal replacement therapy and good clinical outcomes. Logistic elements of SLEDD-f delivery by ICU nursing personnel are satisfactory. Small solute clearance is adequate by available standards for CRRT and intermittent haemodialysis, and larger solute clearance considerable. SLEDD-f is a viable alternative to CRRT in this setting.
- Subjects
KIDNEY diseases; CRITICAL care medicine; INTENSIVE care units; URINALYSIS
- Publication
Nephrology Dialysis Transplantation, 2004, Vol 19, Issue 4, p877
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfg625