From the Guidelines
Sustained low-efficiency dialysis (SLED) is a recommended treatment option for patients with acute kidney injury, particularly those who are hemodynamically unstable, as it allows for gentler fluid removal and solute clearance, reducing the risk of hypotension and other complications.
Key Considerations for SLED
- SLED typically runs for 8-12 hours, using blood flow rates of 100-200 mL/min and dialysate flow rates of 100-300 mL/min 1.
- The slower pace of SLED makes it beneficial for patients who cannot tolerate conventional hemodialysis, as seen in the VA/NIH Acute Renal Failure Trial Network (ATN) study, which found no added benefit with regard to survival or recovery of kidney function associated with more intensive therapy 1.
- Anticoagulation during SLED often involves heparin or citrate, though some patients may not require anticoagulation at all, and the choice of anticoagulant should be determined by patient characteristics, local expertise, nursing comfort, ease of monitoring, and pharmacy issues 1.
Clinical Application of SLED
- SLED is typically performed daily or every other day, depending on the patient's clinical status and metabolic needs, and the main advantages of SLED include reduced nursing workload compared to continuous therapies, lower costs, and the ability to provide effective dialysis to critically ill patients while allowing time for diagnostic or therapeutic procedures during off-dialysis hours.
- The KDIGO Guideline bases their target doses of therapy for both intermittent and continuous therapy on the results of studies such as the RENAL study and the ATN study, which found that neither study was designed to identify the minimum adequate dose of therapy 1.
- Available evidence suggests that delivery of RRT often falls short of the prescribed dose, supporting the need for frequent assessment of the actual delivered dose, and kinetic modeling suggests that the prescription of intermittent hemodialysis to provide a Kt/V of 1.3 three times per week or a Kt/V of 0.65 six times per week are not equivalent 1.
From the Research
Sled Dialysis Overview
- Sled dialysis, also known as sustained low-efficiency dialysis (SLED), is a hybrid technique of renal replacement therapy 2.
- It is performed using standard intermittent hemodialysis equipment with reduced dialysate and blood flow rates, and extended treatment duration 2.
- SLED is considered a viable alternative to traditional continuous renal replacement therapies for critically ill patients in whom intermittent hemodialysis has failed or been withheld 2.
Comparison with Other Dialysis Modalities
- Studies have compared SLED with other dialysis modalities, such as continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) 3, 4, 5.
- However, there is limited direct comparison between SLED and these modalities, and the existing evidence is mostly focused on CAPD and APD 3, 4, 5.
- One study discussed the role of SLED in renal replacement therapy, including its technical aspects and practical advantages 6.
Clinical Applications and Outcomes
- SLED has been used in critically ill patients with acute kidney injury (AKI) and has shown promising results in maintaining hemodynamic stability and achieving prescribed ultrafiltration goals 2.
- However, the evidence on the comparative clinical and patient-reported outcomes of SLED versus other dialysis modalities is limited and uncertain 5.
- Further research is needed to define the exact role of SLED in renal replacement therapy and to compare its outcomes with other dialysis modalities 5, 6.