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Review
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Korean J Med. 2006;71(1):163-163.
- Sustained low-efficiency dialysis (SLED) as an alternative therapy to continuous renal replacement therapy (CRRT) in critically ill patients
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Yong-Bong Shin, Chan-Duck Kim, Sun-Hee Park, Hyeock-Joo Kang, Ja-Yong Park, Yong-Lim Kim
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- Sustained low-efficiency dialysis (SLED) as an alternative therapy to continuous renal replacement therapy (CRRT) in critically ill patients
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아주대학교 의과대학 호흡기내과
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- Abstract
- Background : Although CRRT is commonly used renal replacement therapy in critically ill patients, it has some disadvantages
such as inconvenience, intensive labor, expensiveness and high bleeding risk. Recent studies have shown that SLED can
overcome these shortages of CRRT and also has the advantages of CRRT. We prospectively compared the efficiency, safety,
cost and convenience between SLED and CRRT, and evaluated whether SLED could be complementary substitute to traditional
CRRT. Methods : Forty-six critically ill patients with acute renal failure (ARF) from 2003 to 2005 were treated with SLED
(n=25) and CRRT (n=21). The modality was tended to be selected randomly and based largely on availability of equipments and
not on the clinical status of patients. Mann-Whitney rank-sum test, Fisher's exact test and chi-square test were used for
statistics, and data were described as median value, range from 25th to 75th. Results : The Acute Physiology and Chronic
Health Evaluation (APACHE) II score at the point of ICU admission was 27 for SLED (range 17-32, 25th-75th percentile) and
26 for CRRT (range 19-31) (P=NS). There were no significant differences between the two groups in mean arterial blood
pressure when measured pre-dialysis (83 for SLED vs. 85 for CRRT; P=NS), mid-dialysis (90 vs. 84; P=NS) and at the end of
treatment (88 vs. 80; P=NS). Incidences of hypotension also did not differ between the two groups (P=NS). Ultrafiltration volume
per treatment day was similar in two treatment modalities (2000mL for SLED vs. 2400mL for CRRT; P=NS). Heparin was used
to thirty-one patients (SLED: 18 patients, CRRT: 13 patients) and the dosage of heparin was 2900unit (range 1975-4025) per day
in SLED and 6000unit (range 1962.5-10700) in CRRT (P=0.065). Total clotting number was 4 for SLED and 11 for CRRT (P=NS).
There was also no significant difference in hospital mortality between the two groups (56% for SLED vs. 42.9% for CRRT;
P=NS). But, SLED was superior to CRRT in the aspect of cost and convenience. Conclusion : Our data suggest that SLED
can be used as a useful substitute to traditional CRRT in critically ill ARF patients.
Keywords :
