Haemodynamically Unstable Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis: Outcome in an ICU of Bangladesh

Kaniz Fatema,Mohammad Omar Faruq

doi:10.3329/bmrcb.v42i1.31995

Abstract

Acute kidney injury (AKI) is a risk factor for increased mortality in critically ill patients. Sustained low efficiency dialysis (SLED) is a new approach in renal replacement therapy (RRT) and it combines the advantages of continuous renal replacement therapy (CRRT) and intermittent haemodialysis (HD). The study was aimed to evaluate the outcome of the hae-modynamically unstable patients with AKI in Bangladesh who were treated with SLED. So far this is the first reported study on SLED in intensive care unit (ICU) in Bangladesh. This quasi-experimental study was conducted in a 10-bed adult ICU of a tertiary care hospital in Bangladesh from June 2012 to May 2013. A total of 153 sessions of SLED were performed on 43 AKI patients. Mean age of the patients was 60.12 ± 15.57 years with male preponder-ance (67.4% were male). Mean APACHE II score was 26.88 ± 6.25. Fourteen patients (32.55%) had de novo AKI. Twenty nine patients (67.4%) had chronic kidney disease (CKD) with baseline mean serum creatinine 2.56 mg/dl, but did not require any RRT before admis-sion in ICU. After giving SLED, AKI of the study patients were completely resolved in 27.9%. Some forty two percent patients became dialysis dependant and 30.23% patients died. Patients who had AKI on CKD became dialysis dependant more often than the patients with de novo AKI (p <0.01). Mortality rate was significantly higher in patients who were on inotrope support (p= 0.017). Otherwise, there was no relation of 28 day mortality with age, prior renal function and mechanical ventilator requirement (p>0.05). Thus, SLED is an excellent renal replacement therapy for the haemodynamically unstable AKI patients of ICU. It is also cost-effective compared to CRRT.

Highlights

Acute Kidney Injury (AKI) is a common clinical syndrome with a broad aetiological profile
Hybrid therapy that combines the benefits of intermittent HD and continuous renal replacement therapy (CRRT) has emerged as renal replacement therapy (RRT) in intensive care unit (ICU) patients.[1]
This modality is indicated in different literature with different terms such as ‘sustained low efficiency dialysis’ (SLED), ‘extended daily dialysis’ (EDD), ‘slow low efficient daily dialysis’ (SLEDD) or ‘slow continuous dialysis’ (SCD).[2]

Summary

Introduction

Acute Kidney Injury (AKI) is a common clinical syndrome with a broad aetiological profile It complicates about 5% of hospital admissions and 30% of admissions to ICUs.[1] Patients with chronic kidney disease (CKD) may present with superimposed AKI. Though the ICU patients usually tolerate continuous renal replacement therapy (CRRT) very well, it is very costly and available only in few centres in Bangladesh. Hybrid therapy that combines the benefits of intermittent HD and CRRT has emerged as RRT in ICU patients.[1] This modality is indicated in different literature with different terms such as ‘sustained low efficiency dialysis’ (SLED), ‘extended daily dialysis’ (EDD), ‘slow low efficient daily dialysis’ (SLEDD) or ‘slow continuous dialysis’ (SCD).[2] All have in common use of HD machines, but with blood pump speeds and dialysate flow rates intermediate between intermittent HD and CRRT.

Methods

Discussion

Conclusion