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SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)

Dr. A G Almosewi

AKI is common in the ICU Depending on definition of AKI, up to 50-

60% of patients in the ICU Up to 70% of these will require RRT Independent risk factor for mortality, 50 -

60% mortality in critically ill

Treatment of acute kidney injury (AKI) is principally supportive -- renal replacement therapy (RRT) indicated in patients with severe kidney injury.

Goal: optimization of fluid & electrolyte balance Multiple modalities of RRT : Intermittent hemodialysis (IHD), continuous renal replacement therapies

(CRRTs) hybrid therapies, ie sustained low-efficiency

dialysis (SLED)

PD Least useful form of CRRT in the ICU Inefficient solute/volume clearance if unstable or poor

intestinal blood flow risk of peritonitis Respiratory burden

During the last 9 years, there has been an increasing interest in the use of Sustained Low Efficiency Daily Dialysis (SLEDD)

SLEDD has evolved as a conceptual and technical hybrid of Continuous Renal Replacement Therapy (CRRT) and Intermittent Haemodialysis (IHD) , with therapeutic aims that combine the desirable properties of each of these component modalities

a reduced rate of ultrafiltration for optimal haemodynamic stability

low efficiency solute removal to minimise solute disequilibrium

sustained treatment duration to maximise dialysis dose and attainment of ultrafiltration goal

studies to date appear to be associated with satisfactory outcomes, demonstrating that SLEDD is a safe, effective and convenient renal replacement therapy for patients who were considered inappropriate for IHD.

It is able to achieve ultrafiltration goals in patients who are hypotensive or inotrope dependent.

BACKGROUND There are an increasing number of patients

presenting with AKI requiring Renal Replacement Therapy (RRT) who are considered unsuitable for standard haemodialysis . In order to avoid unnecessary admission of these patients to critical care for continuous renal replacement therapy, modification of existing therapy options has been required to enable these patients to be managed within the renal unit.

DFRBFRduration(hr)modality

500-100300-5002-4 HD

100-300100-2006-12SLEDD

INDICATIONS EDD should be used for those patients with

AKI who are likely to be unsuitable for standard therapy options . This would include

patients at risk of disequilibrium, e.g. very uraemic patients (urea > 50mmol/l), older patients and those with pre)existing CNS disease

those with borderline cardiovascular stability • patients with cardio)renal failure • very fluid overloaded/nephrotic patients • patients requiring inotropic suppor

Advantage Uses conventional dialysis machines Flexibility of duration and intensity Major advantages: flexibility, reduced costs, low or

absent anticoagulation

Our practice 5 pts 1 septic shock 4 cardiogenic shock BP 90\50 11 sessions 2-3 hr \session BFR=100 DFR=300 URR 28%

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Thanks