Good Outcomes with SLED in Critically Ill Patients with AKI

Sustained low-efficiency dialysis (SLED) is an “acceptable alternative” for the treatment of critically ill patients with acute kidney injury (AKI), concludes a study in BMC Nephrology.

The retrospective study included patients with AKI treated at four intensive care units at a Canadian academic medical center between 2007 and 2012. Seventy-four patients were treated with SLED, with a target of 8-hour dialysis sessions at a blood flow rate of 200 mL/min, generally without anticoagulation. The 30-day mortality and other outcomes were compared with those of 158 AKI patients beginning continuous renal replacement therapy (CRRT) at the same intensive care units. The analyses were adjusted for demographic factors, comorbid conditions, baseline kidney function, and Sequential Organ Failure Assessment (SOFA) score.

The two approaches yielded similar 30-day mortality rates: 54 percent with SLED and 61 percent with CRRT. There was also no significant difference in the specified secondary outcomes of dependence on renal replacement therapy at 30 days or early clinical deterioration, defined as an increased SOFA score or death within 48 hours after the start of therapy.

Sustained low-efficiency dialysis is increasingly used as an alternative to CRRT for patients with AKI in hemodynamically unstable condition. Within the study limitations, the new results show similar clinical outcomes for critically ill AKI patients treated with SLED versus CRRT. Pending the outcomes of a definitive noninferiority trial, the researchers conclude, “SLED appears to be an acceptable alternative to CRRT for hemodynamically unstable patients with AKI” [Kitchlu A, et al. Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BMC Nephrol 2015; 16:127].