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Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study.

Kitchlu A, Adhikari N, Burns KE, Friedrich JO, Garg AX, Klein D, Richardson RM, Wald R - BMC Nephrol (2015)

Bottom Line: Mortality at 30 days was 54 % and 61 % among SLED- and CRRT-treated patients, respectively [adjusted odds ratio (OR) 1.07, 95 % CI 0.56-2.03, as compared with CRRT].Among SLED recipients, the risk of RRT dependence at 30 days (adjusted OR 1.36, 95 % CI 0.51-3.57) and early clinical deterioration (adjusted OR 0.73, 95 % CI 0.40-1.34) were not different as compared to patients who initiated CRRT.Notwithstanding the limitations of this small non-randomized study, we found similar clinical outcomes for patients treated with SLED and CRRT.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Nephrology, University of Toronto, Toronto, ON, Canada. abhijat.kitchlu@gmail.com.

ABSTRACT

Background: Sustained low efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. SLED may reduce the hemodynamic perturbations of intermittent hemodialysis, while obviating the resource demands of CRRT. Although SLED is being increasingly used, few studies have evaluated its impact on clinical outcomes.

Methods: We conducted a cohort study comparing SLED (target 8 h/session, blood flow 200 mL/min, predominantly without anticoagulation) to CRRT in four ICUs at an academic medical centre. The primary outcome was mortality 30 days after RRT initiation, adjusted for demographics, comorbidity, baseline kidney function, and Sequential Organ Failure Assessment score. Secondary outcomes were persistent RRT dependence at 30 days and early clinical deterioration, defined as a rise in SOFA score or death 48 h after starting RRT.

Results: We identified 158 patients who initiated treatment with CRRT and 74 with SLED. Mortality at 30 days was 54 % and 61 % among SLED- and CRRT-treated patients, respectively [adjusted odds ratio (OR) 1.07, 95 % CI 0.56-2.03, as compared with CRRT]. Among SLED recipients, the risk of RRT dependence at 30 days (adjusted OR 1.36, 95 % CI 0.51-3.57) and early clinical deterioration (adjusted OR 0.73, 95 % CI 0.40-1.34) were not different as compared to patients who initiated CRRT.

Conclusions: Notwithstanding the limitations of this small non-randomized study, we found similar clinical outcomes for patients treated with SLED and CRRT. While we await the completion of a trial that will definitively assess the non-inferiority of SLED as compared to CRRT, SLED appears to be an acceptable alternative form of renal support in hemodynamically unstable patients with AKI.

No MeSH data available.


Related in: MedlinePlus

Study Flow Diagram
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Fig1: Study Flow Diagram

Mentions: The steps that led to assembly of the analytic cohort are presented in Fig. 1. We identified 562 patients within our AKI Registry at the time of analysis. Of these, we excluded 227 patients who initiated RRT with IHD and 86 patients received their first RRT treatment in a non-ICU setting. Other reasons for exclusion were the mistaken inclusion of patients commencing RRT for ESRD (n = 3); RRT initiation at an outside facility (n = 3); the receipt of isolated ultrafiltration as the initial RRT modality (n = 3); or missing information on initial modality or outcome (n = 8) (Fig. 1). Among the remaining 232 patients, 158 patients received CRRT as their initial RRT modality, and 74 received SLED.Fig. 1


Outcomes of sustained low efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study.

Kitchlu A, Adhikari N, Burns KE, Friedrich JO, Garg AX, Klein D, Richardson RM, Wald R - BMC Nephrol (2015)

Study Flow Diagram
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522955&req=5

Fig1: Study Flow Diagram
Mentions: The steps that led to assembly of the analytic cohort are presented in Fig. 1. We identified 562 patients within our AKI Registry at the time of analysis. Of these, we excluded 227 patients who initiated RRT with IHD and 86 patients received their first RRT treatment in a non-ICU setting. Other reasons for exclusion were the mistaken inclusion of patients commencing RRT for ESRD (n = 3); RRT initiation at an outside facility (n = 3); the receipt of isolated ultrafiltration as the initial RRT modality (n = 3); or missing information on initial modality or outcome (n = 8) (Fig. 1). Among the remaining 232 patients, 158 patients received CRRT as their initial RRT modality, and 74 received SLED.Fig. 1

Bottom Line: Mortality at 30 days was 54 % and 61 % among SLED- and CRRT-treated patients, respectively [adjusted odds ratio (OR) 1.07, 95 % CI 0.56-2.03, as compared with CRRT].Among SLED recipients, the risk of RRT dependence at 30 days (adjusted OR 1.36, 95 % CI 0.51-3.57) and early clinical deterioration (adjusted OR 0.73, 95 % CI 0.40-1.34) were not different as compared to patients who initiated CRRT.Notwithstanding the limitations of this small non-randomized study, we found similar clinical outcomes for patients treated with SLED and CRRT.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Nephrology, University of Toronto, Toronto, ON, Canada. abhijat.kitchlu@gmail.com.

ABSTRACT

Background: Sustained low efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. SLED may reduce the hemodynamic perturbations of intermittent hemodialysis, while obviating the resource demands of CRRT. Although SLED is being increasingly used, few studies have evaluated its impact on clinical outcomes.

Methods: We conducted a cohort study comparing SLED (target 8 h/session, blood flow 200 mL/min, predominantly without anticoagulation) to CRRT in four ICUs at an academic medical centre. The primary outcome was mortality 30 days after RRT initiation, adjusted for demographics, comorbidity, baseline kidney function, and Sequential Organ Failure Assessment score. Secondary outcomes were persistent RRT dependence at 30 days and early clinical deterioration, defined as a rise in SOFA score or death 48 h after starting RRT.

Results: We identified 158 patients who initiated treatment with CRRT and 74 with SLED. Mortality at 30 days was 54 % and 61 % among SLED- and CRRT-treated patients, respectively [adjusted odds ratio (OR) 1.07, 95 % CI 0.56-2.03, as compared with CRRT]. Among SLED recipients, the risk of RRT dependence at 30 days (adjusted OR 1.36, 95 % CI 0.51-3.57) and early clinical deterioration (adjusted OR 0.73, 95 % CI 0.40-1.34) were not different as compared to patients who initiated CRRT.

Conclusions: Notwithstanding the limitations of this small non-randomized study, we found similar clinical outcomes for patients treated with SLED and CRRT. While we await the completion of a trial that will definitively assess the non-inferiority of SLED as compared to CRRT, SLED appears to be an acceptable alternative form of renal support in hemodynamically unstable patients with AKI.

No MeSH data available.


Related in: MedlinePlus