Berbece AN and Richardson RMA (2006) Sustained low-efficiency dialysis in the ICU: cost, anticoagulation, and solute removal. Kidney Int 70: 963–968

Sustained low-efficiency daily dialysis (SLED) has been proposed as a treatment for acute renal failure (ARF) as an alternative to intermittent hemodialysis or continuous renal replacement therapy (CRRT), high-cost modalities associated with coagulation problems, hypotension and poor fluid removal.

In an observational, prospective pilot study, the outcomes of treating 23 ARF patients with SLED were compared with those of 11 undergoing CRRT. The SLED protocol consisted of 8 h hemodialysis/day for 6 days/week (blood flow 200 ml/min; dialysate flows 350 ml/min; hemofiltration with 1 l of saline per hour). Actual mean dialysis durations were 7.5 h/day for SLED and 21.3 h/day for CRRT.

Average weekly costs were US$1,431 for SLED with either heparin or saline flushes, $2,607 for CRRT with heparin, and $3,089 for CRRT with citrate. Two-thirds of SLED treatments were administered without heparin; the rate of filter clotting did not differ significantly between SLED sessions in which heparin or saline flushes were utilized.

SLED was well tolerated, and associated with markedly higher weekly Kt/Vs than CRRT (8.4 vs 7.1; P <0.001). Time-averaged serum creatinine levels were significantly lower in the cohort of patients treated with the former modality (136 vs 95 μmol/l [1.54 mg/dl vs 1.07 mg/dl]; P = 0.03). Ten patients treated with SLED and six treated with CRRT survived to discharge.

These preliminary results indicate that SLED is a safe, efficient and cost-effective alternative to CRRT for ARF that can be routinely performed without the need for anticoagulation.