The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30), SLED (n = 13) or IHD (n = 34) and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if < 90% of the prescribed time was administered. Generalized estimating equations were used to compare the hemodynamic tolerability of SLED vs CRRT while accounting for within-patient clustering of repeated sessions and key confounders.Hemodynamic instability occurred during 22 (56.4%) SLED and 43 (50.0%) CRRT sessions (p = 0.51). In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47), as compared to CRRT. Session interruption occurred in 16 (16.3), 30 (34.9) and 11 (28.2) of IHD, CRRT and SLED therapies, respectively.In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.Acute kidney injury (AKI) is a frequent complication of critical illness, and is associated with high mortality and morbidity [1]. Using contemporary definitions for AKI, renal replacement therapy (RRT) is required in 4-5% of cases [1,2]. The optimal RRT modality in these patients remains controversial.Continuous renal replacement therapy (CRRT) has been advocated in hemodynamically unstable patients as a means of mitigating the blood pressure lability that may occur with conventional intermittent hemodialysis (IHD) [3]. However, studies directly comparing the hemo