Introduction:
Sustained low efficiency dialysis (SLED) is a cost-effective alternative to CRRT in hemodynamically unstable acute kidney injury (AKI) patients in resource limited settings. This single-center prospective observational study aimed to assess the outcomes of SLED in such patients.
Methods:
Patients included were hemodynamically unstable adults (>18 years) with AKI, excluding those able to tolerate conventional hemodialysis. Severity of illness was measured using the Sequential Organ Failure Assessment (SOFA) score. Treatment duration and ultrafiltration rates were adjusted based on individual patient needs and hemodynamic stability were recorded. Dialysis dependence, renal function recovery, and mortality rates at discharge and at one-month of post-discharge were analyzed.
Results:
Out of 128 ICU patients requiring dialysis, 78 underwent SLED, while 43 received intermittent hemodialysis and 3 received CRRT. Among SLED patients, mean age of 51.22 years, predominantly male (61.5%), with common comorbidities such as hypertension (29.5%) and diabetes mellitus (25.6%). Sepsis (78.2%) and hypoperfusion (58.7%) were the primary causes of AKI. Indications for SLED initiation included refractory fluid overload (97.4%) and metabolic acidosis (92.3%). A significant proportion required mechanical ventilation (39.7%), and 72% had SOFA scores >12. Over one year, 216 SLED sessions were conducted, with 68.98% completed without adverse events, although 31% were terminated prematurely due to hemodynamic instability. SLED effectively corrected metabolic acidosis in 56.4% of cases and achieved planned ultrafiltration in 62% of sessions. However, in-hospital mortality was high at 57.69%, with an additional 2.6% mortality at one month follow-up. Multivariate analysis identified vasopressin requirement, mechanical ventilation, and SOFA scores >12 as predictors of mortality
Conclusions:
Present study demonstrated SLED is a reasonable and cost-effective RRT option for hemodynamically unstable AKI patients, particularly in resource-limited settings.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.