What is SLED (Symptomatic Low-Efficiency Daily dialysis)?

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From the Guidelines

SLED (Symptomatic Low-Efficiency Daily dialysis) is a type of prolonged intermittent renal replacement therapy (RRT) that can be safely used in hemodynamically unstable adult patients.

Key Characteristics of SLED

  • It is a complementary therapy to continuous RRT (CRRT) and intermittent hemodialysis (IHD)
  • SLED can offer comparable results to CRRT in terms of hemodynamic stability 1
  • It is technically less complex and less demanding than CRRT, with some centers citing the relative ease of delivering therapy as an advantage of SLED 1

Clinical Use of SLED

  • SLED can be used as an alternative to CRRT in settings where other forms of CRRT are not available 1
  • It may enable the administration of RRT in centers that have dialysis capability but not necessarily CRRT 1
  • SLED can be used interchangeably with CRRT, with no implication of being an inferior alternative 1

Nutritional Considerations

  • SLED can result in amino acid and peptide/protein losses, with a reported loss of up to 15-20 g/d and 5-10 g/d, respectively 1
  • The use of SLED may contribute to a limited amount of energy (100-300 kcal/d) that should be factored into the patient's prescribed energy intake 1

From the Research

Definition of SLED

  • SLED stands for Symptomatic Low-Efficiency Daily dialysis, also known as Sustained Low-Efficiency Dialysis 2, 3, 4, 5, 6
  • It is a type of renal replacement therapy used to treat patients with acute kidney injury (AKI) in the intensive care unit (ICU) 2, 3, 4, 5, 6

Characteristics of SLED

  • SLED combines excellent detoxification and good cardiovascular tolerability for even severely ill patients in the ICU 2
  • It provides good treatment time flexibility at lower costs than continuous renal replacement therapy (CRRT) 2
  • SLED can be performed using standard dialysis equipment with reduced dialysate and blood flow rates 4, 5
  • Treatment duration can vary from 4 to 12 hours, with 4-hour SLED being a viable option to spare time and manpower during hospitalization 6

Clinical Outcomes of SLED

  • SLED has been shown to provide similar clinical outcomes to CRRT in terms of mortality, renal recovery, and hospital stay 3
  • It can achieve good solute control and hemodynamic stability, with minimal complications 4, 5
  • SLED has been associated with favorable clinical outcomes, including improved renal parameters, AKI recovery, and survival 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

[SLED v CRRT: the choice between a Rolls and a Ferrari?].

Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2013

5
Research

Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2004

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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