Dialytic techniques in critical patients: slow low-efficient daily dialysis or CVVHDF?

Introduction

In critically unstable patients, conventional dialysis is difficult to perform and continuous methods have been the treatment of choice. The use of mixed dialytic techniques such as slow low-efficient daily dialysis (SLEDD) offers the combined advantages of conventional haemodialysis and continuous dialytic techniques.

Objectives

To compare the costs/efficacy/efficiency as well as nurse care between SLEDD and continuous techniques (CVVHDF).

Materials and methods

A retrospective and comparative study was performed considering both methods from 1 October 2003 to 31 March 2004. The study evaluated the following parameters: number of patients enrolled, age, gender, number of procedures, APACHE II score, SAPS II score, heparin consumption, volume extracted, duration of procedures, blood pumping speed, BUN clearance and costs.

Results

The authors compared SLEDD with 24-hour CVVHDF. The urea clarification rate with SLEDD was 48.3% compared with 37% with CVVHDF; creatinine clearance in SLEDD was 43% compared with 31.7% with CVVHDF; economic advantages were also compared per technique (€37.50 vs €235 in SLEDD and CVVHDF, respectively). Heparin used in SLEDD was 4400 IU compared with 12,000 in CVVHDF.

Conclusion

SLEDD was more efficient in removing urea and creatinine and was well tolerated in haemodynamically unstable patients. Each SLEDD session was six times less expensive than each 24-hour session of CVVHDF. SLEDD also permitted access to daily dialysis in more patients, a lower nurse workload and better time management in patient care.