Feasibility and Hemodynamic Tolerability of Sustained Low- Efficiency Dialysis in Critically Ill Patients with Acute Kidney Injury

Introduction: AKI is a common complication of critical illness. Management of AKI may require the initiation of RRT to correct metabolic and fluid derangements. CRRT does have some advantages over conventional intermittent dialysis in critical care settings. The main disadvantage of CRRT is its exorbitant cost. SLED is a hybrid technique between CRRT and IHD, done using conventional HD machines and dialyzers.

Materials and Methods: The primary objective of the study was to determine the hemodynamic tolerability & feasibility of SLED in critically ill patients with AKI. All patients admitted to the ICU; who was started on SLED was included in this study. Data on demographic information, pre-dialysis Biochemical & Hematological parameters were collected. BP and vasopressor requirements during the SLED sessions were recorded. Survival predictors were described using a SOFA score at the time of initiation of the first SLED session.

Results: 427 SLED sessions were conducted in 148 patients. Two patients suffered from cardiac arrest during the SLED session. There was an increased requirement of inotropic support in 56 sessions which was labeled as a hemodynamically unstable session. Hypotension refractory to inotropic medication, requiring SLED discontinuation occurred in 14 sessions. 97.7% of the prescribed duration of treatment and 89.07% of the ultrafiltration goal was achieved with SLED in this study.

Conclusion: SLED is a well-tolerated, feasible, cost-effective RRT modality in resource-limited settings for critically ill patients with AKI.