Saturday December 24, 2005
Is SLEDD better than CVVHD in ICU patients ?

With advent of Continuous Veno-Venous Hemodialysis (CVVHD) we found some relief for our hemodynamically unstable patients with acute renal failure but CVVHD has its own cons with need of more trained staffing, cost, time, anticoagulation issues, nutrition issues etc. To find a path between two modalities (conventional HD and CVVHD), new literature is suggesting that slow extended daily hemodialysis (SLEDD) may be more or atleast equally effective. Click on Reference 1 to see small study of 20 patients comparing SLEDD and CVVHD. Nephrol Dial Transplant (2004) also found SLEDD as an effective alternative. As concluded in Intensive Care Nephrology 2000 that "..advantages (of CRRT) can, however, also be obtained with SLEDD. In addition, SLEDD is less expensive than CRRT and does not continuously immobilize the patient, leaving time open for other activities..".3 Or probably the skills and the experience of the physicians and nurses who perform dialysis are more important than the applied dialysis modalities. 4

References: Click to get articles/abstract
1. Comparison of slow extended daily hemodialysis (SLEDD) to continuous renal replacement therapy in acute renal failure patients in the intensive care unit (ICU) - Abstract no: 18, Kidney International Society Abstracts.
2. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy - Nephrol Dial Transplant (2004) 19: 877-884
3. What Is the Renal Replacement Method of First Choice for Intensive Care Patients? - J Am Soc Nephrol 12:S40-S43, 2001
4. Dialysing the patient with acute renal failure in the ICU: the emperor's clothes? - Nephrol Dial Transplant (1999) 14: 2570-25735. Daily Hemodialysis and the Outcome of Acute Renal Failure - NEJM, Jan. 2002, Volume 346:305-310