SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)
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This document discusses sustained low-efficiency daily dialysis (SLEDD) for treating acute kidney injury (AKI) in critically ill patients. SLEDD is a hybrid therapy that combines aspects of continuous renal replacement therapy and intermittent hemodialysis. It allows for a reduced ultrafiltration rate and prolonged treatment duration to maximize dialysis dose while maintaining hemodynamic stability. The document outlines the indications for SLEDD, including patients at risk of disequilibrium or with borderline cardiovascular stability. Preliminary studies suggest SLEDD is a safe and effective option for AKI patients otherwise unsuitable for standard therapies.
SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD)
- 1. . SUSTAINED LOW EFFICIENCY DAILY DIALYSIS (SLEDD) Dr. A G Almosewi
- 2. 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
- 3. 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)
- 4. 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
- 5. During the last 9 years, there has been an increasing interest in the use of Sustained Low Efficiency Daily Dialysis (SLEDD)
- 6. 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
- 7. 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
- 8. 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.
- 9. It is able to achieve ultrafiltration goals in patients who are hypotensive or inotrope dependent.
- 10. 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.
- 11. DFR BFR duration(hr) modality 500-100 300-500 2-4 HD 100-300 100-200 6-12 SLEDD
- 12. 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
- 13. Advantage Uses conventional dialysis machines Flexibility of duration and intensity Major advantages: flexibility, reduced costs, low or absent anticoagulation
- 14. Our practice 5 pts 1 septic shock 4 cardiogenic shock BP 9050 11 sessions 2-3 hr session BFR=100 DFR=300 URR 28%
- 15. . Thanks