Sustained low efficiency dialysis in the continuous mode (C-SLED): dialysis efficacy, clinical outcomes, and survival predictors in critically ill cancer patients.
OBJECTIVE
Oliguric, hypotensive patients who require large amounts of fluids may benefit from sustained low-efficiency dialysis performed continuously (C-SLED). C-SLED through higher clearance may improve survival, or through greater nutritional loss may worsen survival. No studies have assessed survival on C-SLED. The objective was to examine patient outcomes and survival predictors on C-SLED.


METHODS
The data of 199 consecutive cancer patients treated with C-SLED were analyzed. The median duration of C-SLED was 50 h. With 48 h of C-SLED, the blood urea nitrogen (BUN) and serum creatinine levels had decreased by 80% and 73%, respectively. The mean arterial pressure (MAP) was maintained despite higher ultrafiltration and reduced vasopressor use. The 30-d mortality rate was 65%. Despite excellent dialysis, the sequential organ failure assessment (SOFA) score remained predictive of mortality. In the univariate model, higher SOFA scores and lower values for MAP, blood pH, and serum albumin and creatinine levels were associated with higher mortality. Administration of total parenteral nutrition (TPN) was, however, associated with lower mortality.


RESULTS
In the multivariate model, the higher SOFA score and lower blood pH, MAP and C-SLED duration were associated with higher mortality. In a subset analysis of 129 patients who received C-SLED for at least 48 h, those with higher BUN levels, which were associated with higher TPN infusion, had a lower mortality risk.


CONCLUSIONS
This first detailed report on C-SLED indicates that C-SLED can be effective and suggests a link between nutrition and survival.
Salahudeen
Abdulla K
AK
Nephrology Section, Department of General Internal Medicine AT&EC, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. aksalahudeen@mdanderson.org
Kumar
Vikas
V
Madan
Niti
N
Xiao
Lianchun
L
Lahoti
Amit
A
Samuels
Joshua
J
Nates
Joseph
J
Price
Kristen
K
D058186:Acute Kidney Injury / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D003401:Creatine / Q000097:blood; D016638:Critical Illness; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D010289:Parenteral Nutrition, Total; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D012709:Serum Albumin; D003401:Creatine