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Archetypal sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring kidney replacement therapy: towards an adequate therapy

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Abstract

Sustained low-efficiency dialysis is a hybrid form of kidney replacement therapy that has gained increasing popularity as an alternative to continuous forms of kidney replacement therapy in intensive care unit settings. During the COVID-19 pandemic, the shortage of continuous kidney replacement therapy equipment led to increasing usage of sustained low-efficiency dialysis as an alternative treatment for acute kidney injury. Sustained low-efficiency dialysis is an efficient method for treating hemodynamically unstable patients and is quite widely available, making it especially useful in resource-limited settings. In this review, we aim to discuss the various attributes of sustained low-efficiency dialysis and how it is comparable to continuous kidney replacement therapy in efficacy, in terms of solute kinetics and urea clearance, and the various formulae used to compare intermittent and continuous forms of kidney replacement therapy, along with hemodynamic stability. During the COVID-19 pandemic, there was increased clotting of continuous kidney replacement therapy circuits, which led to increased use of sustained low-efficiency dialysis alone or together with extra corporeal membrane oxygenation circuits. Although sustained low-efficiency dialysis can be delivered with continuous kidney replacement therapy machines, most centers use standard hemodialysis machines or batch dialysis systems. Even though antibiotic dosing differs between continuous kidney replacement therapy and sustained low-efficiency dialysis, reports of patient survival and renal recovery are similar for continuous kidney replacement therapy and sustained low-efficiency dialysis. Health care studies indicate that sustained low-efficiency dialysis has emerged as a cost-effective alternative to continuous kidney replacement therapy. Although there is considerable data to support sustained low-efficiency dialysis treatments for critically ill adult patients with acute kidney injury, there are fewer pediatric data, even so, currently available studies support the use of sustained low-efficiency dialysis for pediatric patients, particularly in resource-limited settings.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India

    Sidharth Sethi

  2. Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA

    Guneive Mangat, Anvitha Soundararajan, Abhilash Bhat Marakini, Raghav Shah & Rupesh Raina

  3. School of Medicine, Pontificia Universidade Catolica Do Parana, Curitiba, Brazil

    Roberto Pecoits-Filho

  4. Arbor Research Collaborative for Health, Ann Arbor, MI, USA

    Roberto Pecoits-Filho

  5. UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK

    Andrew Davenport

  6. Department of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, USA

    Rupesh Raina

  7. Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA

    Rupesh Raina

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  1. Sidharth Sethi
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  2. Guneive Mangat
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  4. Abhilash Bhat Marakini
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Contributions

SKS and GM conceptualized the manuscript. SKS, GM, AS, ABM, RPF, AD, RS, RR wrote the manuscript. AD, SKS, and RR critically reviewed and edited the manuscript. RS created the graphical abstract. 

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Correspondence to Rupesh Raina.

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Sethi, S., Mangat, G., Soundararajan, A. et al. Archetypal sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring kidney replacement therapy: towards an adequate therapy. J Nephrol 36, 1789–1804 (2023). https://doi.org/10.1007/s40620-023-01665-1

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