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

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.

Indications for Dialysis in Acute Kidney Injury

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, 

scholarly journals Hemodynamic Tolerability of Sustained Low Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury

2017 ◽  
Vol 6 (2) ◽  
pp. 84-90
Author(s):  
Kaniz Fatema ◽  
Mohammad Omar Faruq ◽  
Md Mozammel Hoque ◽  
ASM Areef Ahsan ◽  
Parvin Akter Khanam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Low Efficiency

Background: Sustained low efficiency dialysis (SLED) has been evolved in recent years as technical hybrid of continuous renal replacement therapy and intermittent hemodialysis. It offers optimized hemodynamic stability of the critically ill patients with acute kidney injury (AKI). Our aim was to evaluate the hemodynamic tolerability of SLED in hemodynamically unstable patients with AKI.Methods: This prospective experimental study was conducted in Intensive Care Unit of BIRDEM General Hospital, Dhaka over a period of one year.Results: Forty three hemodynamically unstable patients with AKI were treated with one fifty three sessions of SLED. Mean arterial pressure of the patients before starting dialysis were 80.58±10.92 mmHg and 69.8% patients were on inotrope support. There were no significant differences (p>0.05) in mean arterial pressure during the procedure. No significant changes (p>0.05) occurred in pulse, respiratory rate and temperature during the sessions. Only thirty six out of 153 SLED sessions were associated with complications and hypotension was the commonest one (20.26%). Hypotensive episodes were effectively managed with addition or dose escalation of inotropes. No dialysis had to be discontinued because of hypotension/arrhythmia.Conclusion: SLED is an effective renal replacement therapy for the critically ill patients with AKI which maintains their hemodynamic stability.Birdem Med J 2016; 6(2): 84-90

scholarly journals Prevalence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

2020 ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Southeast Asia ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Intermittent Hemodialysis ◽  
Predictability Score ◽  
Epidemiology Data ◽  
Low Efficiency

Abstract Background : Currently, there is limited epidemiology data on acute kidney injury (AKI) from Southeast Asia, especially from Indonesia which is one of the biggest countries in Southeast Asia. Therefore, we assessed the prevalence of AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : Demographic and clinical data were collected from 952 ICU participants. The participants were categorized into AKI and non-AKI groups. The participants were further classified according to the 3 different stages of AKI as per the Kidney Disease Improving Global Outcome (KDIGO) criteria. We then assessed the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI participants. RRT modalities were listed according to the number of times the procedures were carried out. Results : Overall incidence of AKI was 43%. The participants were divided into three groups based on the AKI stages: 18.5 % had stage 1, 33% had stage 2, and 48.5 % had stage 3. The use of mechanical ventilation was higher among the participants with AKI compared to the non-AKI participants. Also, AKI participants had higher average APACHE score compared to the non-AKI participants (16.5 vs 9.9). Among the AKI participants, 24.6% required RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low-efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions : This study showed that AKI is a common problem in the Indonesian ICU and had a high mortality rate. We strongly believe that identification of the risk factors associated with AKI will help us to develop a predictability score for AKI so we can prevent and improve AKI outcome in the future.

Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

2018 ◽  
pp. 221-226
Author(s):  
Eric Ehieli ◽  
Yuriy Bronshteyn
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Statistical Difference ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Replacement Strategy ◽  
Therapy Regimen ◽  
Continuous Venovenous Hemodiafiltration ◽  
Multicenter Prospective Study

Patients with severe acute kidney injury who require renal replacement therapy have high mortality rates. Controversy exists over whether a mortality benefit occurs with use of a more intensive renal replacement therapy regimen. In this multicenter, prospective study, 1124 patients requiring renal replacement therapy for severe acute kidney injury were randomized to a more and a less intensive renal replacement therapy regimen and were followed for 60 days. There was no statistical difference in mortality at 60 days (53.6% intensive, 51.5% less intensive, P = 0.47) and no difference in kidney recovery or non-renal organ failure. Hypotension and electrolyte abnormalities were more common in the intensive renal replacement regimen. A less intensive renal replacement regimen (intermittent hemodialysis 3 times a week or continuous venovenous hemodiafiltration at 20ml/kg/hour) was found noninferior to a more intensive renal replacement strategy (dialysis 6 times per week or continuous venovenous hemodiafiltration at 35 ml/kg/hour).

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

scholarly journals Haemodynamically Unstable Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis: Outcome in an ICU of Bangladesh

2017 ◽  
Vol 42 (1) ◽  
pp. 14-20
Author(s):  
Kaniz Fatema ◽  
Mohammad Omar Faruq
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
De Novo ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Cost Effective ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Low Efficiency

Acute kidney injury (AKI) is a risk factor for increased mortality in critically ill patients. Sustained low efficiency dialysis (SLED) is a new approach in renal replacement therapy (RRT) and it combines the advantages of continuous renal replacement therapy (CRRT) and intermittent haemodialysis (HD). The study was aimed to evaluate the outcome of the hae-modynamically unstable patients with AKI in Bangladesh who were treated with SLED. So far this is the first reported study on SLED in intensive care unit (ICU) in Bangladesh. This quasi-experimental study was conducted in a 10-bed adult ICU of a tertiary care hospital in Bangladesh from June 2012 to May 2013. A total of 153 sessions of SLED were performed on 43 AKI patients. Mean age of the patients was 60.12 ± 15.57 years with male preponder-ance (67.4% were male). Mean APACHE II score was 26.88 ± 6.25. Fourteen patients (32.55%) had de novo AKI. Twenty nine patients (67.4%) had chronic kidney disease (CKD) with baseline mean serum creatinine 2.56 mg/dl, but did not require any RRT before admis-sion in ICU. After giving SLED, AKI of the study patients were completely resolved in 27.9%. Some forty two percent patients became dialysis dependant and 30.23% patients died. Patients who had AKI on CKD became dialysis dependant more often than the patients with de novo AKI (p <0.01). Mortality rate was significantly higher in patients who were on inotrope support (p= 0.017). Otherwise, there was no relation of 28 day mortality with age, prior renal function and mechanical ventilator requirement (p>0.05). Thus, SLED is an excellent renal replacement therapy for the haemodynamically unstable AKI patients of ICU. It is also cost-effective compared to CRRT.

scholarly journals Continuous renal replacement therapy: understanding the foundations applied to pediatric patients

2019 ◽  
pp. S39-S45
Author(s):  
Evelyn Obando ◽  
Eliana López ◽  
David Montoya ◽  
Jaime Fernández Sarmiento
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Rational Approach ◽  
Daily Dialysis ◽  
Continuous Renal Replacement Therapies

Continuous renal replacement therapy (CRRT) is a well-established supportive treatment for acute kidney injury in pediatric intensive care units. Knowing its basic aspects allows a rational approach to therapy, making this therapeutic option a more adaptable treatment for individual patient. Different strategies may be used in the same child, depending on the clinical situation and the changes that may present throughout the clinical course. This article explains the physical principles, modalities of continuous renal replacement therapies, and membrane and filter characteristics in order to better understand the transmembrane transport of fluids and solutes in continuous renal replacement therapy.Abbreviations: CRRT= Continuous renal replacement therapy; SCUF = Slow continuous ultrafiltration therapies; FF = Filtration fraction; CVVH = Continuous venovenous hemofiltration; AKI = Acute kidney injury; CVVHD = Continuous venovenous hemodialysis; CVVHDF = Continuous venovenous hemodiafiltration; SLEDD = Sustained low-efficiency daily dialysis, EDDf = Extended daily dialysis with filtration, PDIRRT = Prolonged daily intermittent renal replacement therapyCitation: Obando E, López E, Montoya D, Fernández-Sarmiento J. Continuous renal replacement therapy: understanding the foundations applied to pediatric patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S39-S45

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