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

Abstract

IntroductionAcute kidney injury (AKI) is associated with a high mortality of up to 60%. The mode of renal replacement therapy (intermittent versus continuous) has no impact on patient survival. Sustained low efficiency dialysis using a single-pass batch dialysis system (SLED-BD) has recently been introduced for the treatment of dialysis-dependent AKI. To date, however, only limited evidence is available in the comparison of SLED-BD versus continuous veno-venous hemofiltration (CVVH) in intensive care unit (ICU) patients with AKI.MethodsProspective, randomized, interventional, clinical study at a surgical intensive care unit of a university hospital. Between 1 April 2006 and 31 January 2009, 232 AKI patients who underwent renal replacement therapy (RRT) were randomized in the study. Follow-up was assessed until 30 August 2009. Patients were either assigned to 12-h SLED-BD or to 24-h predilutional CVVH. Both therapies were performed at a blood flow of 100 to 120 ml/min.Results115 patients were treated with SLED-BD (total number of treatments n = 817) and 117 patients with CVVH (total number of treatments n = 877).The primary outcome measure, 90-day mortality, was similar between groups (SLED: 49.6% vs. CVVH: 55.6%, P = 0.43). Hemodynamic stability did not differ between SLED-BD and CVVH, whereas patients in the SLED-BD group had significantly fewer days of mechanical ventilation (17.7 ± 19.4 vs. 20.9 ± 19.8, P = 0.047) and fewer days in the ICU (19.6 ± 20.1 vs. 23.7 ± 21.9, P = 0.04). Patients treated with SLED needed fewer blood transfusions (1,375 ± 2,573 ml vs. 1,976 ± 3,316 ml, P = 0.02) and had a substantial reduction in nursing time spent for renal replacement therapy (P < 0.001) resulting in lower costs.ConclusionsSLED-BD was associated with reduced nursing time and lower costs compared to CVVH at similar outcomes. In the light of limited health care resources, SLED-BD offers an attractive alternative for the treatment of AKI in ICU patients.Trial registrationClinicalTrials.gov NCT00322530

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

“…12 This study also had male preponderance (67.4%). Similar gender distribution was observed in the SLED study by Schwenger 13 (62.6% male), Carvalho 1 (60% male) and Kilhara 14 (male 54.5%).…”

Regional Citrate Anticoagulation for RRTs in Critically Ill Patients with AKI

“…Sustained low-efficiency dialysis, also known as extended daily dialysis, is a prolonged intermittent RRT (PIRRT) usually lasting 8-12 hours that is increasingly used in patients with AKI in the ICU (12,(72)(73)(74)(75)(76). PIRRT is considered a hybrid RRT modality; it combines the main advantages of conventional intermittent forms of RRT (e.g., standard hemodialysis equipment, online-produced dialysate, flexible scheduling, and lower costs) with those of CRRT (e.g., better hemodynamic tolerance, excellent metabolic control, and gentle osmotic fluctuation and fluid removal capacity) (74,(77)(78)(79)(80)(81).…”

Sepsis and Renal Replacement Therapy

“…Sustained Low Efficiency Dialysis using a Single-Pass Batch Dialysis system (SLED-BD) to a 24 h predilutional CVVH in renal replacement therapy dependent AKI patients admitted to a surgical intensive care unit in Germany. Whereas there was no difference in 90-day mortality between groups (SLED: 49.6% vs. CVVH: 55.6%, P = 0.43), patients in the SLED-BD group had significantly fewer days of mechanical ventilation (17.7 ± 19.4 vs. 20.9 ± 19.8, P = 0.047) and shorter time for renal recovery (P = 0.049) resulting in lower cost [31]. Meta-analysis study by Zhang, et al comparing Extended Daily Dialysis (EDD), defined as HD or hemodiafiltration between 6 to 24 hours per session, versus CRRT in AKI patients also confirmed similar mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P = 0.3) [32] (Table 3).…”