Abstract
Objective: This study aimed to compare the hemodynamic tolerability and efficacy of sustained low-efficiency dialysis (SLED) versus continuous veno-venous hemodialysis (CVVHD) in critically ill patients with acute kidney injury (AKI).
Design: A prospective observational comparative study.
Setting: The study was conducted in the Critical Care Departments of Cairo University Teaching Hospitals, Misr University for Science and Technology Hospitals, and Kobry El Kobba Military Hospital between March 2018 and April 2019.
Patients and participants: A total of 60 hemodynamically unstable patients diagnosed with AKI were included. Patients were divided into two groups: 30 underwent SLED, and 30 received CVVHD.
Interventions: Patients were managed using either SLED or CVVHD as part of their renal replacement therapy (RRT). Hemodynamic parameters, laboratory markers, dialysis efficiency, and patient outcomes were evaluated.
Measurements and results: Baseline characteristics, including age, gender, cardiac status, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, were comparable between the groups. CVVHD demonstrated superior solute removal, with significantly higher urea reduction ratio (URR) (40% vs 29%, p=0.006), and creatinine reduction ratio (CRR) (38% vs 25%, p=0.001). SLED showed a greater improvement in serum bicarbonate levels (17% vs 4%, p<0.001). Fluid removal was significantly higher in CVVHD (3.3±0.34 l vs 2.2±0.52 l, p<0.001). No significant differences were observed in hemodynamic stability, arrhythmia occurrence, or vasopressor use. Patients in the SLED group had a significantly longer duration of mechanical ventilation (5.53±1.83 vs 3.25±1.25 days, p<0.001) and ICU stay (9.5±4.8 vs 6.4±1.46 days, p=0.001). Mortality rates were similar between groups (63.3% vs 63.3%, p=1).
Conclusions: Both SLED and CVVHD were well-tolerated hemodialysis modalities for critically ill patients with AKI, demonstrating comparable hemodynamic stability and mortality rates. While CVVHD provided superior solute clearance and fluid removal, SLED was more effective in correcting metabolic acidosis and allowed for greater patient mobility. These findings suggest that SLED is a feasible and cost-effective alternative to CVVHD in hemodynamically unstable patients requiring RRT.
Mohamed Hosny Abdallah, Hossam Eldin Ahmed Mowafy, Hazem Abdelhamid Elakavawy, Mohamed Omar Elghonimy, Mostafa Mahmoud Elshahat Ali Saleh
Mohamed Hosny Abdalla
