70 Sustained Low Efficiency Daily Dialysis (SLEDD) in the ICU: Outcomes Compared to Intermittent Hemodialysis (IHD)

Background: In patients with renal failure, gadolinium-based contrast agents (GBCA) can be removed by intermittent hemodialysis (iHD) to prevent possible toxic effects. There is no data on the efficacy of GBCA removal via sustained low efficiency daily dialysis (SLEDD) which is mainly used in intensive care unit (ICU) patients. Methods: We compared the elimination of the GBCA gadobutrol in 6 ICU patients treated with SLEDD (6–12 h, 90 L dialysate) with 7 normal ward inpatients treated with iHD (4 h, dialysate flow 500 mL/min). Both groups received 3 dialysis sessions on 3 consecutive days starting after the application of gadobutrol. Blood samples were drawn before and after each session and total dialysate, as well as urine was collected. Gadolinium (Gd) concentrations were measured using mass spectrometry and eliminated Gd was calculated from dialysate and urine. Results: The initial mean plasma Gd concentration was 385 ± 183 µM for the iHD and 270 ± 97 µM for the SLEDD group, respectively (p > 0.05). The Gd-reduction rate after the first dialysis session was 83 ± 9 and 67 ± 9% for the iHD and the SLEDD groups, respectively (p = 0.0083). The Gd-reduction rate after the second and third dialysis was 94–98 and 89–96% for the iHD and the SLEDD groups (p > 0.05). The total eliminated Gd was 89 ± 14 and 91 ± 4% of the dose in the iHD and the SLEDD groups, respectively (p > 0.05). Gd dialyzer clearance was 95 ± 22 mL/min and 79 ± 19 mL/min for iHD and SLEDD, respectively (p > 0.05). Conclusions: Gd-elimination with SLEDD is equally effective as iHD and can be safely used to remove GBCA in ICU patients.

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16 Sustained Low Efficiency Dialysis (SLED) in Burn Patients with Acute Kidney Injury

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.021 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S16-S17

Author(s):

Andrea Danielle Kassay ◽

Alexander Adibfar ◽

Robert Cartotto

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Hospital Length Of Stay ◽

Intermittent Hemodialysis ◽

Burn Patients ◽

Dialysate Flow Rate ◽

Daily Dialysis ◽

Low Efficiency

Abstract Introduction Acute Kidney Injury (AKI) is common among patients with major burns and may require treatment with renal replacement therapy (RRT). Although continuous renal replacement therapy (CRRT) modalities are widely used and offer many advantages over traditional intermittent hemodialysis (IHD), CRRT is expensive, labour-intensive, and may not be available in some burn centers. Sustained Low Efficiency Dialysis (SLED) is a moderately efficient alternative to IHD, but its use in burn patients with AKI has not been described. The purpose of this study was to review our experience with SLED. Methods Retrospective review of adult burn patients with AKI treated by SLED between 07/2013 and 03/2020 at an adult regional ABA-verified burn center. Data was obtained from the electronic medical record including daily dialysis forms completed by the nephrology service. Values are shown as mean +/- SD or median (IQR) as appropriate. Results We evaluated 367 distinct SLED sessions provided to 33 patients [age 55.8 +/- 14 yrs., %TBSA burn 33 +/-19, % TBSA full thickness burn 10.5 (0, 35.8), and 54.5% with inhalation injury]. The serum creatinine (sCr) prior to the start of SLED was 2.96 (2.3, 4.17) mg/dL. SLED was initiated 5 (3, 10.8) days (range 0–24 d) post burn, and 7 (3.3, 12.8) sessions (range 1–44) with a duration of 4 (4,6) hours each were given per patient. Heparinization was required in 22 sessions (6%), and 46 sessions (12.5%) were aborted, most commonly due to clotting of the lines or circuit, and rarely (4%) due to hypotension. The net ultrafiltrate removal was 1.2 (0.7–2) L, with a dialysate flow rate of 350 (350, 500) mL/min. Among 208 sessions where patients were not on vasopressors (VPs) Pre-SLED, one or more VPs were required in 19 sessions (9%) during or at the termination of SLED. Among 116 sessions where patients were receiving norepinephrine (NEpi) infusions pre-SLED, the NEpi dose dropped from 7.3 +/- 4.2 µgm/min to 6 +/- 4.5 µgm/min (p=0.03). Pre and Post SLED values for blood pressure, creatinine, and potassium are shown in the table. The mortality rate was 36.4%, hospital length of stay was 42 (20.5, 61.5) days, and among surviving patients, 2 (9.5%) required dialysis post discharge. Conclusions SLED was effective and well tolerated. Hemodynamic instability was infrequently encountered.

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Comparative Study of Chronic Renal Failure Patients' Efficacy Between Sustained Low-efficiency Daily Dialysis (SLEDD) and Intermittent Hemodialysis (IHD)

Hong Kong Journal of Nephrology ◽

10.1016/j.hkjn.2015.09.218 ◽

2015 ◽

Vol 17 (2) ◽

pp. S130

Author(s):

Yiying Tao ◽

Wenbo Hu

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Comparative Study ◽

Intermittent Hemodialysis ◽

Daily Dialysis ◽

Low Efficiency

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Indications for Dialysis in Acute Kidney Injury

10.2310/nephro.12038 ◽

2020 ◽

Author(s):

Ankit Patel ◽

Kenneth B Christopher

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

High Efficiency ◽

Kidney Injury ◽

Intermittent Hemodialysis ◽

Continuous Venovenous Hemofiltration ◽

Continuous Venovenous Hemodialysis ◽

Low Efficiency ◽

The Impact

Renal replacement therapy (RRT) can be used to support patient’s kidney function in cases of acute kidney injury (AKI). However, timing, modality, and dosing of RRT continue to remain in question. Recent studies have begun to provide data to help guide clinicians on when to initiate RRT, what form of RRT to use ranging from continuous venovenous hemofiltration (VVH) to intermittent hemodialysis, and the impact of high versus low-intensity dosing. Additionally, the risks associated with temporary vascular access with regard to thrombosis and infection, the impact of high efficiency and flux versus low efficiency and flux membranes, and options for anticoagulation in RRT for AKI are also discussed. This review contains 75 references. Key words: acute kidney injury, chronic kidney disease, continuous venovenous hemofiltration, continuous venovenous hemodialysis, renal replacement therapy, venovenous hemofiltration,

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Sustained low-efficiency daily dialysis with hemofiltration for acute kidney injury in the presence of sepsis

Clinical Nephrology ◽

10.5414/cnp69040 ◽

2008 ◽

Vol 69 (01) ◽

pp. 40-46 ◽

Cited By ~ 14

Author(s):

B.G. Holt ◽

J.J. White ◽

A. Kuthiala ◽

P. Fall ◽

H.M. Szerlip

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Daily Dialysis ◽

Low Efficiency

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Removal of linezolid by conventional intermittent hemodialysis, sustained low-efficiency dialysis, or continuous venovenous hemofiltration in patients with acute renal failure

Critical Care Medicine ◽

10.1097/01.ccm.0000147687.06808.92 ◽

2004 ◽

Vol 32 (12) ◽

pp. 2437-2442 ◽

Cited By ~ 70

Author(s):

Enrico Fiaccadori ◽

Umberto Maggiore ◽

Carlo Rotelli ◽

Roberto Giacosa ◽

Elisabetta Parenti ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intermittent Hemodialysis ◽

Continuous Venovenous Hemofiltration ◽

Low Efficiency

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Treatment of metformin-associated lactic acidosis with sustained low-efficiency daily dialysis

Clinical Kidney Journal ◽

10.1093/ndtplus/sfn090 ◽

2008 ◽

Vol 1 (5) ◽

pp. 380-381

Author(s):

A. Teutonico ◽

P. Libutti ◽

C. Lomonte ◽

M. Antonelli ◽

F. Casucci ◽

...

Keyword(s):

Lactic Acidosis ◽

Daily Dialysis ◽

Low Efficiency

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Drug Dosing Considerations in Critically Ill Patients Receiving Continuous Renal Replacement Therapy

Pharmacy ◽

10.3390/pharmacy8010018 ◽

2020 ◽

Vol 8 (1) ◽

pp. 18 ◽

Cited By ~ 1

Author(s):

Soo Min Jang ◽

Sergio Infante ◽

Amir Abdi Pour

Keyword(s):

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Patient Specific ◽

Therapeutic Drug ◽

Intermittent Hemodialysis ◽

Drug Dosing ◽

Low Efficiency

Acute kidney injury is very common in critically ill patients requiring renal replacement therapy. Despite the advancement in medicine, the mortality rate from septic shock can be as high as 60%. This manuscript describes drug-dosing considerations and challenges for clinicians. For instance, drugs’ pharmacokinetic changes (e.g., decreased protein binding and increased volume of distribution) and drug property changes in critical illness affecting solute or drug clearance during renal replacement therapy. Moreover, different types of renal replacement therapy (intermittent hemodialysis, prolonged intermittent renal replacement therapy or sustained low-efficiency dialysis, and continuous renal replacement therapy) are discussed to describe how to optimize the drug administration strategies. With updated literature, pharmacodynamic targets and empirical dosing recommendations for commonly used antibiotics in critically ill patients receiving continuous renal replacement therapy are outlined. It is vital to utilize local epidemiology and resistance patterns to select appropriate antibiotics to optimize clinical outcomes. Therapeutic drug monitoring should be used, when possible. This review should be used as a guide to develop a patient-specific antibiotic therapy plan.

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Renal Replacement Therapy in Intensive Care Unit at a Tertiary Care Center in Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v21i1.24858 ◽

2019 ◽

Vol 21 (1) ◽

pp. 74-79

Author(s):

Pramod Kumar Chhetri ◽

DN Manandhar ◽

P Poudel ◽

S Baidya ◽

SB Raju ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Care Center ◽

Tertiary Care ◽

Intermittent Hemodialysis ◽

Low Efficiency

Acute kidney injury is a major complication in intensive care unit patients. It is associated with increased in-hospital mortality and length of stay. The provision of renal replacement therapy in intensive care is not widely available in resource poor countries like Nepal. The study aims to look into clinical profile and outcome of patients who received renal replacement therapy in intensive care unit. It was an observational study done from 1st October 2016 till 30th September 2017. Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacement therapy were recorded. Statistical package for the social sciences version 17 was used for statistical analysis. There were total of 649 admissions in intensive care, among which 148 had kidney related complications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, urea and creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/ dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacement therapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysis as the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septic shock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significant for in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation which was statistically significant for in-hospital mortality (p<0.001). Sustained low efficiency dialysis can be done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

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