A Comparative Nonrandomised Observational Study of Different Modalities of Renal Replacement Therapy (Continuous...

This study investigated the comparable efficacy of sustained low-efficiency dialysis (SLED) over continuous renal replacement therapy (CRRT) in maintaining hemodynamic stability in critically ill patients with acute kidney injury (AKI) in an intensive care unit (ICU).

A single-centre, prospective observational study was conducted at Jaslok Hospital and Research Centre, Mumbai, involving 67 patients requiring RRT in the ICU. Thirty-five patients were included in the CRRT (Baxter Prismaflex System, USA) cohort, and 32 patients were included in the SLED (Fresenius 4008S, Fresenius Medical Care, Bad Hamburg, Germany) cohort. A total of 58 sessions of CRRT and 87 sessions of SLED were analysed.

The median duration of CRRT was 1.93 days, whereas the median duration of SLED was 0.73 days. The mean duration of dialysis and mean ultrafiltration rate per session were 46.48+/-37.65 hours and 17.61+/-13.2 hours, and 23.77+/-26.72ml/hr and 103.51+/-108 ml/hr, respectively, in the CRRT and SLED cohorts. Metrics such as the Delta VI, Delta VD, Sequential Organ Failure Assessment (SOFA), and Acute Physiological Assessment and Chronic Health Evaluation (APACHE-2) Scores were evaluated within 48 hours of therapy initiation, along with 28-day mortality rates and complication assessments. The mortality rates at 48 hours and all-cause mortality rates at 28 days were 45.71% and 50% and 77.14% and 78.12% between the CRRT and SLED cohorts, respectively. Between survivors and nonsurvivors, the SOFA and APACHE-2 scores showed statistical significance. A SOFA score of ≥11 and an APACHE II score of >20 are associated with a negative short-term outcome. During the process of therapy, complications of clinical significance were filter clotting, hypokalemia, hypophosphatemia, and arrhythmias. Although we could not observe statistically significant differences between the groups, they could still contribute towards untoward outcomes if left untreated.

While both therapies showed similar baseline characteristics and outcomes, the SLED demonstrated a potential advantage in terms of reduced filter clotting incidents and logistics, making it an attractive alternative in resource-limited settings. The results highlight the equivalent efficacy of the SLED in delivering RRT while supporting hemodynamic stability in critically ill patients.