RENAL SUPPORT IN CRITICALLY ILL LIVER DISEASE PATIENTS WITH AKI– ACUTE PD VS. SLED: EXPERIENCES FROM A TERTIARY CARE CENTRE IN NORTHEAST INDIA

Introduction:

The management of acute kidney injury (AKI) in critically ill patients with chronic liver disease presents significant challenges due to the hemodynamic alterations, increased susceptibility to infections, and other complications such as ascites. This study aims to evaluate and compare the efficacy of acute peritoneal dialysis (PD) and sustained low-efficiency dialysis (SLED) in achieving and maintaining adequate solute clearance, fluid balance, and overall renal support in this vulnerable patient population. The objective is to provide evidence that will inform clinical decision-making, optimizing care and outcomes for patients with both liver dysfunction and renal impairment.

Methods:

This retrospective study was conducted over one year at a tertiary care center in Northeast India. The study included patients admitted to the ICU with AKI and chronic liver disease who required dialysis. Patients were randomly divided into two groups: Group A received Acute Peritoneal Dialysis (PD), and Group B received Sustained Low-Efficiency Dialysis (SLED). The study focused on both primary outcomes (such as correction of uraemia, metabolic acidosis, fluid overload, dyselectrolytemia, and mortality) and secondary outcomes (including improvement in sensorium, hemodynamic stability, ICU length of stay, cost of treatment, and duration of mechanical ventilation).

Results:

The study included a total of 117 patients with chronic liver disease and acute kidney injury (AKI) who required dialysis.

Significant acidosis was present in 90% in PD group and 27% in SLED group. SLED had a better correction of acidosis in comparison to PD. Correction of fluid overload was faster in SLED. PD group had a better hemodynamic stability (p=0.03) and cost of treatment was also cheaper. No significant differences between groups was seen in correction of hyperkalemia, improvement in sensorium, mortality (39% vs 36%), renal function recovery.

Conclusions:

Acute PD still remains a viable alternative to SLED in critically ill patients in low cost settings. Advantages include its low cost, ease of administration, requirement of less expertise and its metabolic and clinical outcomes are not inferior to SLED.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.