INTRODUCTION AND AIMS: Sustained Low Efficiency Dialysis (SLED) is an intermittent renal replacement therapy hybrid between intermittent high flow dialysis and continous renal replacement therapies. Given that the superiority of the use of continuous renal replacement techniques compared to intermittent techniques has not been found, choice depends on the avaiability and expertise. The main objective of this work was to describe the characteristics of patients receiving SLED therapy following individual, non-protocolized, nephrologist’s indication in the intensive care units (ICU) of our hospital. As a secondary objective, it was considered to study the complications of the technique as regards hemodynamic tolerance.
METHODS:A retrospective study of the registry of ICU patients that were treated with SLED was done including those that recived SLED as the first therapeutic option, immediately after receiving continuous renal replacement therapy (CRRT) or after receiving high flow intermittent hemodialysis (HFIHD) during the years 2014-2016. SLED session was defined with QB 100-150 ml / min, QD 200-250 ml / min and dialysis time of 7-8 hours. The presence of hemodynamic instability in a session was defined as the need to initiate or increase vasoactive drugs (VAD) during the session according to the nursing reporting, systolic blood pressure (SBP) drop <90 mmHg or a decrease of> 25% of SBP or DBP during the session. In-hospital mortality was considered.
RESULTS: A total of 54 patients were analyzed, of which 26 had received the therapy after performing a HFIHD, 11 as the first renal replacement technique and 17 as the first option after CRRT. The characteristics of the different groups are described in the following table. With regard to renal function recovery, among patients who were not receiving dialysis as a chronic treatment nor were exitus during admission (n=21), 66.6% recovered their basal renal function, but 19% were receiving dialysis at discharge. Most SLED treatments are indicated after conventional hemodialysis, poorly tolerated. Patient profile is a VAD carrier and mostly intubated when we use the technique as a step from CRRT.In the case of hemodynamic tolerance, 67% of the sessions were well tolerated and none of them had to be interrupted due to hemodynamic intolerance. Of all the patients who were indicated the SLED technique after a poorly tolerated high flow hemodialysis, only 11.5% ended up receiving continuous techniques, which makes us think that the technique has fulfilled its objective of maintaining the intermitent modality.
CONCLUSIONS: SLED is an intermittent renal replacement therapy that is not widespread in our ICU patients as a first treatment but is more commonly used as an intermediate step between high flow hemodialysis and CRRT. We believe that, if we expand its knowledge, it can recover a major role as it’s a well-tolerated technique.
Comments