Sustained Low-Efficiency Dialysis as an Alternative Therapy to Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

Shin, Yong Bong; Cho, Jang Hee; Park, Ja Yong; Choi, Ji Young; Park, Sun Hee; Kim, Chan Duck; Kim, Yong Lim

Abstract

PURPOSE
Although continuous renal replacement therapy (CRRT) is commonly used as a renal replacement therapy in critically ill patients with acute kidney injury, it has some disadvantages such as inconvenience, intensive labor, expensiveness and high bleeding risk. Recent studies have shown that sustained-low efficiency dialysis (SLED) can overcome these shortages of CRRT and also has the advantages of CRRT. We prospectively compared the efficiency, safety, cost and convenience between SLED and CRRT, and evaluated whether SLED could be a complementary substitute to traditional CRRT.
METHODS
Forty-six critically ill patients with acute kidney injury (AKI) from 2003 to 2005 were treated with SLED (n=25) and CRRT (n=21). The modality was tended to be selected randomly and based largely on availability of equipments and not on the clinical status of patients. Mann-Whitney rank-sum test, Fisher's exact test and chi-square test were used for statistics, and data were described as median value, range from 25th to 75th.
RESULTS
The Acute Physiology and Chronic Health Evaluation (APACHE) II score at the point of ICU admission was 27 for SLED (range 17-32, 25-75th percentile) and 26 for CRRT group (range 19-31) (p=NS). There were no significant differences between the two groups in mean arterial blood pressure when measured pre-dialysis (83 for SLED vs. 85 for CRRT; p=NS), mid-dialysis (90 vs. 84; p=NS) and at the end of treatment (88 vs. 80; p=NS). Incidences of hypotension also did not differ between the two groups (p=NS). Ultrafiltration volume per treatment day was similar in two treatment modalities (2,000 mL for SLED vs. 2,400 mL for CRRT; p=NS). Heparin was used to thirty-one patients (SLED: 18 patients, CRRT: 13 patients). The dosage of heparin tended to be lower in SLED (2,900 unit per day for SLED vs. 6,000 unit per day for in CRRT, p=0.065). Total clotting number was 4 for SLED and 11 for CRRT (p=NS). There was also no significant difference in hospital mortality between the two groups (56% for SLED vs. 42.9% for CRRT; p=NS). SLED was superior to CRRT in the aspect of cost and convenience.
CONCLUSION
Our data suggest that SLED can be used as a useful substitute to traditional CRRT in critically ill patients with AKI.