Prevention of Intradialytic Hypotension in Patients with Acute Kidney Injury Submitted to Sustained Low-Efficiency Dialysis

Renal Failure ◽  
2012 ◽  
Vol 34 (10) ◽  
pp. 1238-1243 ◽  
Author(s):  
Emerson Q. Lima ◽  
Ricardo G. Silva ◽  
Endrigo L.S. Donadi ◽  
Alex B. Fernandes ◽  
Jeferson R. Zanon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Intradialytic Hypotension ◽  
Low Efficiency

scholarly journals Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis

2020 ◽  
Vol 49 (5) ◽  
pp. 306-311
Author(s):  
Attaphong Phongphitakchai ◽  
Ussanee Boonsrirat
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Serum Levels ◽  
Tertiary Hospital ◽  
Bleeding Complications ◽  
Intradialytic Hypotension ◽  
Risk Of Death ◽  
Increased Risk ◽  
Predictive Outcome ◽  
Low Efficiency

Introduction: Sustained low efficiency dialysis (SLED) is an increasingly common treatment option for acute kidney injury (AKI) patients, but there are few studies examining the survival and predictive outcome of this therapy. The study aims to evaluate survival, pre-SLED predictors and complications associated with SLED. Materials and Methods: This was a retrospective cohort study of 91 patients with AKI treated with SLED in a tertiary hospital from January 2014 to August 2018. The primary outcomes were in-hospital and 30-day mortality. The secondary outcomes were the clinical and laboratory pre-SLED characteristics that were associated with survival and complication of SLED. Results: Median survival of AKI patients treated with SLED was 17 days and the 30-day mortality rate was 58%. Pre-SLED serum levels of creatinine (adjusted HR 0.82, 95% CI 0.71x0.94), albumin (adjusted HR 0.57, 95% CI 0.4–0.81), potassium (adjusted HR 1.38, 95% CI 1.1–1.73) and number of SLED (adjusted HR 0.95, 95% CI 0.91-1) served as predictors of survival. Arrhythmia was found 3.3% and intradialytic hypotension in 13.2% of patients. No patient had bleeding complications. Conclusions: Our study found similar in-hospital and 30-day mortality for AKI patients treated with SLED. High pre-SLED levels of serum albumin, creatinine and number of SLED were significantly associated with reduced risk of death and high pre-SLED serum potassium was associated with increased risk of death. These results indicate that SLED is safe treatment, with few haemorrhage and haemodynamic complications. Key words: Acute kidney injury, Predictors, Sustained low efficiency dialysis, Survival

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, 

Sustained low-efficiency dialysis for metformin-associated lactic acidosis in patients with acute kidney injury

2018 ◽  
Vol 32 (2) ◽  
pp. 297-306 ◽  
Author(s):  
Paolo Greco ◽  
Giuseppe Regolisti ◽  
Umberto Maggiore ◽  
Elena Ferioli ◽  
Filippo Fani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Lactic Acidosis ◽  
Kidney Injury ◽  
Low Efficiency

scholarly journals Principles of Drug Dosing in Sustained Low Efficiency Dialysis (SLED) and Review of Antimicrobial Dosing Literature

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 33
Author(s):  
Paula Brown ◽  
Marisa Battistella
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Critically Ill Patients ◽  
Dose Adjustment ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Drug Dosing ◽  
Low Efficiency ◽  
Preliminary Recommendation ◽  
Selection Of

The use of sustained low-efficiency dialysis (SLED) as a renal replacement modality has increased in critically ill patients with both acute kidney injury (AKI) and hemodynamic instability. Unfortunately, there is a paucity of data regarding the appropriate dosing of medications for patients undergoing SLED. Dose adjustment in SLED often requires interpretation of pharmacodynamics and pharmacokinetic factors and extrapolation based on dosing recommendations from other modes of renal replacement therapy (RRT). This review summarizes published trials of antimicrobial dose adjustment in SLED and discusses pharmacokinetic considerations specific to medication dosing in SLED. Preliminary recommendation is provided on selection of appropriate dosing for medications where published literature is unavailable.

scholarly journals Acute kidney injury management using intermittent low efficiency haemodiafiltration in a critical care unit: 39 dogs (2012–2015)

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
Maxime Cambournac ◽  
Isabelle Goy-Thollot ◽  
Julien Guillaumin ◽  
Jean-Yves Ayoub ◽  
Céline Pouzot-Nevoret ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Critical Care Unit ◽  
Kidney Injury ◽  
Injury Management ◽  
Low Efficiency

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

2008 ◽  
Vol 69 (01) ◽  
pp. 40-46 ◽  
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

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 Management and outcome assessment of pregnancy-related acute kidney injury in Western India: a single centred, prospective, observational study

2021 ◽  
Vol 9 (6) ◽  
pp. 1655
Author(s):  
Vipul Gattani ◽  
Maulin K. Shah
Keyword(s):  
Acute Kidney Injury ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Western India ◽  
Intrauterine Death ◽  
Born Child ◽  
Intermittent Haemodialysis ◽  
Low Efficiency

Background: Pregnancy-related acute kidney injury (PRAKI) remains a large public health problem, with decreasing incidences in developing countries like India. However, some single centred studies from United States and Canada revealed an increasing incidence of PRAKI. This increase could be due to higher rates of hypertensive disorders of pregnancy.Methods: To assess the management and outcome of PRAKI. In this prospective, observational study, total 1021 cases of acute renal failure were observed.Results: 96 (9.4%) were of obstetric origin and enrolled as per inclusion criteria. Regarding management of PRAKI, 78 out of 96 (81.25%) required haemodialysis. 67 (69.79%) among them were managed with intermittent haemodialysis (IHD) while 10 (10.41%) who had hypotension at presentation were dialysed with slow, low efficiency dialysis (SLED). Continuous renal replacement therapy (CRRT) was done in 1 (10.4%) patient. Maternal mortality in this PRAKI study was 19 of 96 patients (19.79%). Sepsis accounted for 52.63% of deaths. Foetal death was observed in 58 out of 96 patients (60.41%) comprising of intrauterine death in 55 (55.29%) and abortion in 3 (3.13%) patients. 38 of 96 (39.58%) patients gave birth to live born child out of which 27 were at full term and 11 were preterm.Conclusions: In order to avoid further increase in PRAKI in India, treating obstetrician should remain aware of management and outcome of PRAKI. The better awareness of diagnosis and management protocols will ultimately lead to further reduction in prevalence of PRAKI in our country.

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