SLEDD Offers No Advantage Over IHD
LAS VEGAS—Sustained low-efficiency daily dialysis (SLEDD) for intensive care unit (ICU) patients does not offer a survival advantage over intermittent hemodialysis (IHD), data suggest.
George Coritsidis, MD, and collaborators at Elmhurst Hospital Center-Mount Sinai Medical School in Elmhurst, NY, compared 66 ICU patients treated with SLEDD and 65 ICU patients who received IHD. The two groups were similar with respect to age, admission APACHE II scores, and serum albumin.
The mean duration of the first SLEDD treatment was 6.1± 2.8 hours, with subsequent treatments of 7.4±0.4 hours, and average blood flow rates of 150 mL/hour. The three-day and in-hospital mortality rates were 31.8% and 71.2% in the SLEDD group compared with 15.4% and 44.6%% in the IHD patients, according to findings presented at the National Kidney Foundation's Spring Clinical Meetings. Among patients with AKI, the rates were 78.8% and 48.4%. For both comparisons, the difference in mortality risk disappeared after adjusting for acuity and vasopressor use.
The average post-dialysis phosphate was significantly lower in the SLEDD patients than IHD patients (5.11 vs. 6.6 mmol/L). Four episodes of post-RRT hypophosphatemia occurred in the SLEDD group compared with only one in the IHD group. Fourteen episodes of post-RRT hypokalemia occurred in the SLEDD group compared with nine in the IHD group. The average post-dialysis potassium was significantly higher in the SLEDD than IHD patients (4.88 vs. 4.06 mEq/L).
Significantly more patients in the SLEDD group than the IHD group required vasopressors (79% vs. 34%).
Lastly, when comparing combined IHD vs. SLEDD populations based on pre-RRT APACHE II tertiles (less than 20, 20-28, greater than 28), the researchers observed no significant difference in mortality between the groups. Actual mortalities were comparable to calculated APACHE risk.