title: The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury.
abstract: BACKGROUND
  Minimization of hemodynamic instability during renal replacement therapy (RRT) in patients with acute kidney injury (AKI) is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD).
  
  
  METHODS
  This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30), SLED (n = 13) or IHD (n = 34) and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if < 90% of the prescribed time was administered. Generalized estimating equations were used to compare the hemodynamic tolerability of SLED vs CRRT while accounting for within-patient clustering of repeated sessions and key confounders.
  
  
  RESULTS
  Hemodynamic instability occurred during 22 (56.4%) SLED and 43 (50.0%) CRRT sessions (p = 0.51). In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47), as compared to CRRT. Session interruption occurred in 16 (16.3), 30 (34.9) and 11 (28.2) of IHD, CRRT and SLED therapies, respectively.
  
  
  CONCLUSIONS
  In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Fieghen
authors.forename: Jan O
authors.initials: JO
authors.lastname: Friedrich
authors.forename: Karen E
authors.initials: KE
authors.lastname: Burns
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.forename: Neill K
authors.initials: NK
authors.lastname: Adhikari
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Hladunewich
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lapinsky
authors.forename: Robert M
authors.initials: RM
authors.lastname: Richardson
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards; D013997:Time Factors