ICU SAQs · Renal / RRT
Choice of SLED for a haemodynamically marginal patient with AKI
A CICM SAQ on the SLED — the middle-ground modality for the haemodynamically marginal patient, the advantages over the IHD (tolerance) and the CRRT (resources, anticoagulation, down-time), and the prescription (blood flow, dialysate flow, duration).
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Prompt
A 68-year-old with the AKI and the pneumonia requires the RRT. The BP is marginal on the low-dose vasopressor. The unit has the standard haemodialysis machines but the limited CRRT capacity. Justify the choice of the SLED and describe the prescription.
Question
A patient with AKI and pneumonia needs renal replacement therapy while on a low-dose vasopressor; the unit has standard haemodialysis machines but limited CRRT capacity. Justify SLED and outline the prescription.[1]
References7ShowHide
- [1]Schwenger V, Weigand MA, Hoffmann O, et al. Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the REnal Replacement Therapy Study in Intensive Care Unit PatiEnts Crit Care, 2012.PMID 22839577
- [2]Kielstein JT, Kretschmer U, Ernst T, et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study Am J Kidney Dis, 2004.PMID 14750100
- [3]Berbece AN, Richardson RMA Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal Kidney Int, 2006.PMID 16850023
- [4]Palevsky PM, Zhang JH, O'Connor TZ, et al. Intensity of renal support in critically ill patients with acute kidney injury N Engl J Med, 2008.PMID 18492867
- [5]Marshall MR, Golper TA, Shaver MJ, et al. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy Kidney Int, 2001.PMID 11473662
- [6]Clark JA, Schulman G, Golper TA Safety and efficacy of regional citrate anticoagulation during 8-hour sustained low-efficiency dialysis Clin J Am Soc Nephrol, 2008.PMID 18272829
- [7]Dalbhi SA, Alorf R, Alotaibi M, et al. Sustained low efficiency dialysis is non-inferior to continuous renal replacement therapy in critically ill patients with acute kidney injury: A comparative meta-analysis Medicine (Baltimore), 2021.PMID 34941056