Sustained low-efficiency dialysis (SLED) in a referral hospital in Latin America

Abstract

Sustained Low-Efficiency Dialysis (SLED) is a hybrid modality of renal replacement therapy used in critically ill patients, although there is little evidence in pediatric patients.

Objective: To describe the experience with the use of SLED in a critically ill pediatric population over five years in a hospital in Colombia. Patients and Method: Descriptive observational study. All patients < 17 years of age with acute kidney injury who required SLED therapy in the pediatric intensive care unit were included. A descriptive statistical analysis and an exploratory analysis were performed to evaluate the change in laboratory tests before and after dialysis.

Results: 524 SLED sessions performed in 28 patients with acute kidney injury of different etiologies were included. The median age was 12 years (range 3-17 years), and 11% of the sessions were in patients under 20 kg. The main indication for SLED was fluid overload in 54% of sessions, followed by anuria in 37%. All laboratory tests showed a statistically significant improvement after SLED therapy. Complications occurred in 21% of sessions, with a predominance of intradialytic electrolyte imbalances (8%) and catheter dysfunction (5%). Mortality was 11%.

Conclusion: SLED therapy in critically ill children is safe, with few intradialytic adverse effects such as hypotension and catheter dysfunction, and few post-dialysis complications (electrolyte imbalance). It is an effective modality for improving laboratory parameters (blood urea nitrogen, bicarbonate, and hyperkalemia).