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Introduction and Aims: Incidence of acute kidney injury (AKI) is still rising and associated with high mortality in critical ill patients. We examined solute and volume removal, and the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED) and continuous veno-venous hemodiafiltration (CVVHDF) in critically ill patients with AKI.

Methods: This study encompassed five critical care units within a single university hospital (Jan- Dec. 2013). Sixty consecutive critically ill patients with AKI who were treated with CVVHDF (n = 30), SLED (n = 30) were included in the study. Overall, 133 RRT sessions were analyzed. Hemodynamic instability during sessions was defined as the composite of an intradialytic >20% reduction in mean arterial pressure, occurrence of arrhythmia or the need to escalate vasopressors. Severity of acute illness was described using APACHE II score.

VariablesGroup 1
(SLED)
N=30		Group 2
(CVVHDF)
N=30		P
Gender
Male
Female		19 (63.3%)
11 (36.7%)		21 (70%)
9 (30%)		>0.05
Ejection
fraction (Mean+SD)		0.53±0.140.47±0.10>0.05
APPACHE II
15-20
20-25
25-30
30-35
>35		3(10%)
8 (26.7%)
3 (10%)
9 (30%)
7 (23.3%)		1 (3.3%)
2 (6.7%)
9 (30%)
10 (33.3%)
8 (26.7%)		>0.05
VariablesGroup 1
(SLED)
N=30		Group 2
(CVVHDF)
N=30		P
Gender
Male
Female		19 (63.3%)
11 (36.7%)		21 (70%)
9 (30%)		>0.05
Ejection
fraction (Mean+SD)		0.53±0.140.47±0.10>0.05
APPACHE II
15-20
20-25
25-30
30-35
>35		3(10%)
8 (26.7%)
3 (10%)
9 (30%)
7 (23.3%)		1 (3.3%)
2 (6.7%)
9 (30%)
10 (33.3%)
8 (26.7%)		>0.05
VariablesGroup 1
(SLED)
N=30		Group 2
(CVVHDF)
N=30		P
Gender
Male
Female		19 (63.3%)
11 (36.7%)		21 (70%)
9 (30%)		>0.05
Ejection
fraction (Mean+SD)		0.53±0.140.47±0.10>0.05
APPACHE II
15-20
20-25
25-30
30-35
>35		3(10%)
8 (26.7%)
3 (10%)
9 (30%)
7 (23.3%)		1 (3.3%)
2 (6.7%)
9 (30%)
10 (33.3%)
8 (26.7%)		>0.05
VariablesGroup 1
(SLED)
N=30		Group 2
(CVVHDF)
N=30		P
Gender
Male
Female		19 (63.3%)
11 (36.7%)		21 (70%)
9 (30%)		>0.05
Ejection
fraction (Mean+SD)		0.53±0.140.47±0.10>0.05
APPACHE II
15-20
20-25
25-30
30-35
>35		3(10%)
8 (26.7%)
3 (10%)
9 (30%)
7 (23.3%)		1 (3.3%)
2 (6.7%)
9 (30%)
10 (33.3%)
8 (26.7%)		>0.05
VariablesGroup 1 N=77 sessionsGroup 2 N=56 sessionsP
CRR0.32+0.120.40+0.16<0.001
URR0.38+0.160.48+0.14<0.05
K change (%)12%±310%±2.4>0.05
HCO3 change (%)17%±54%±0.6<0.001
Mean UF (L)2.23.3<0.001
MBP change (%)10.9%10.2%>0.05
Intradialytic hypotension
No
Yes		44 (56.7%)
33 (43.3%)		30 (53.4%)
26 (46.6%)		>0.05
Intradialytic arrhythmia No Yes58 (76.7%) 19 (23.3%)39(70%) 17 (30%)>0.05
Vasopressor need No The same Decreased Increased10 (35.7%) 10 (35.7%) 5 (17.9%) 3 (10.7%)6 (27.3%) 9(40.9%) 6(27.3%) 1(4.5%)>0.05
VariablesGroup 1 N=77 sessionsGroup 2 N=56 sessionsP
CRR0.32+0.120.40+0.16<0.001
URR0.38+0.160.48+0.14<0.05
K change (%)12%±310%±2.4>0.05
HCO3 change (%)17%±54%±0.6<0.001
Mean UF (L)2.23.3<0.001
MBP change (%)10.9%10.2%>0.05
Intradialytic hypotension
No
Yes		44 (56.7%)
33 (43.3%)		30 (53.4%)
26 (46.6%)		>0.05
Intradialytic arrhythmia No Yes58 (76.7%) 19 (23.3%)39(70%) 17 (30%)>0.05
Vasopressor need No The same Decreased Increased10 (35.7%) 10 (35.7%) 5 (17.9%) 3 (10.7%)6 (27.3%) 9(40.9%) 6(27.3%) 1(4.5%)>0.05
VariablesGroup 1 N=77 sessionsGroup 2 N=56 sessionsP
CRR0.32+0.120.40+0.16<0.001
URR0.38+0.160.48+0.14<0.05
K change (%)12%±310%±2.4>0.05
HCO3 change (%)17%±54%±0.6<0.001
Mean UF (L)2.23.3<0.001
MBP change (%)10.9%10.2%>0.05
Intradialytic hypotension
No
Yes		44 (56.7%)
33 (43.3%)		30 (53.4%)
26 (46.6%)		>0.05
Intradialytic arrhythmia No Yes58 (76.7%) 19 (23.3%)39(70%) 17 (30%)>0.05
Vasopressor need No The same Decreased Increased10 (35.7%) 10 (35.7%) 5 (17.9%) 3 (10.7%)6 (27.3%) 9(40.9%) 6(27.3%) 1(4.5%)>0.05
VariablesGroup 1 N=77 sessionsGroup 2 N=56 sessionsP
CRR0.32+0.120.40+0.16<0.001
URR0.38+0.160.48+0.14<0.05
K change (%)12%±310%±2.4>0.05
HCO3 change (%)17%±54%±0.6<0.001
Mean UF (L)2.23.3<0.001
MBP change (%)10.9%10.2%>0.05
Intradialytic hypotension
No
Yes		44 (56.7%)
33 (43.3%)		30 (53.4%)
26 (46.6%)		>0.05
Intradialytic arrhythmia No Yes58 (76.7%) 19 (23.3%)39(70%) 17 (30%)>0.05
Vasopressor need No The same Decreased Increased10 (35.7%) 10 (35.7%) 5 (17.9%) 3 (10.7%)6 (27.3%) 9(40.9%) 6(27.3%) 1(4.5%)>0.05

Results: Intradialytic hypotension occurred in 33 out of 77 sessions (43.3%) SLED and 26 out of 56 sessions (46.6%) CVVHDF sessions (p = >0.05). Intradialytic arrhythmia occurred in 19 out of 77 sessions (23.3%) SLED and 17 out of 56 sessions (30%) CVVHDF sessions (p = >0.05). Mean ultrafiltration with CVVHDF (3.3 l), SLED (2.2 l), (p = <0.001). Creatinine reduction ratio (CRR) during SLED 0.32+0.12 and CVVHDF 0.40+0.16, (p <0.001). Urea reduction ratio (URR) after SLED 0.38+0.16 and CVVHDF 0.48+0.14 (p <0.05). Serum bicarbonate was corrected better with SLED 17%±5 than CVVHDF 4%±0.6 (P < 0.001).

Conclusions: SLED had comparable hemodynamic tolerability to CVVHDF, with better correction of acidosis, but with less solute and volume removal. Both modalities left no impact upon patients’ survival.

© The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Topic:
Issue Section:
Poster Session > DIALYSIS. EXTRACORPOREAL DIALYSIS: TECHNIQUES AND ADEQUACY
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