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

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

Renal Failure ◽

10.3109/0886022x.2012.723581 ◽

2012 ◽

Vol 34 (10) ◽

pp. 1238-1243 ◽

Cited By ~ 13

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

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

Journal of Nephrology ◽

10.1007/s40620-018-00562-2 ◽

2018 ◽

Vol 32 (2) ◽

pp. 297-306 ◽

Cited By ~ 6

Author(s):

Paolo Greco ◽

Giuseppe Regolisti ◽

Umberto Maggiore ◽

Elena Ferioli ◽

Filippo Fani ◽

...

Keyword(s):

Acute Kidney Injury ◽

Lactic Acidosis ◽

Kidney Injury ◽

Low Efficiency

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Correction: Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts

Critical Care ◽

10.1186/cc11815 ◽

2012 ◽

Vol 16 (5) ◽

pp. 451 ◽

Cited By ~ 4

Author(s):

Vedat Schwenger ◽

Markus A Weigand ◽

Oskar Hoffmann ◽

Ralf Dikow ◽

Lars P Kihm ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Single Pass ◽

Interventional Trial ◽

Batch System ◽

Low Efficiency

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

Pharmacy ◽

10.3390/pharmacy8010033 ◽

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.

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

Acta Veterinaria Scandinavica ◽

10.1186/s13028-019-0452-6 ◽

2019 ◽

Vol 61 (1) ◽

Cited By ~ 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

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Single- and multiple-dose pharmacokinetics and total removal of colistin in a patient with acute kidney injury undergoing extended daily dialysis

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dku075 ◽

2014 ◽

Vol 69 (7) ◽

pp. 2008-2010 ◽

Cited By ~ 18

Author(s):

A.-K. Strunk ◽

J. J. Schmidt ◽

E. Baroke ◽

S. M. Bode-Boger ◽

J. Martens-Lobenhoffer ◽

...

Keyword(s):

Acute Kidney Injury ◽

Multiple Dose ◽

Kidney Injury ◽

Total Removal ◽

Daily Dialysis ◽

Multiple Dose Pharmacokinetics

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

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v42i1.31995 ◽

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.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20212232 ◽

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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