Utilization of slow low-efficiency dialysis may help to optimize the need for continuous renal replacement therapy in Indian ICUs

Introduction

The aim was to study the practice pattern of using the modern modalities of renal replacement therapy (RRT) (slow low-efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT)) in hemodynamically unstable critically ill patients in an Indian ICU.

Methods

A retrospective observational study of hemodynamically unstable patients with acute kidney injury (AKI) who needed RRT in ICUs of a tertiary-care hospital. All patients who underwent SLED and/or CRRT from September 2005 to April 2008 were taken up for analysis. To maintain a mean arterial pressure (MAP) >70 mmHg, patients who required noradrenaline >0.5 μg/kg/minute were treated with CRRT whereas those requiring ≤ 0.5 μg/kg/minute received SLED. Depending on haemodynamic stability patients were switched from CRRT to SLED, or vice versa.

Results

From September 2005 to April 2008, 214 haemodynamically unstable AKI patients, deemed unfit for intermittent haemodialysis, underwent SLED/CRRT (continuous venovenous hemofiltration (CVVH)/continuous venovenous hemodiafiltration (CVVHDF)). Ten patients were switched to SLED after a median 48 hours of CRRT. See Figures 1 and 2.

Figure 1

(abstract P271)

Figure 2

(abstract P271)

Conclusion

In our ICU, the need for RRT in hemodynamically unstable patients with AKI was significantly higher in the medical patients, the commonest cause of AKI being sepsis. Patients who were equally sick (comparable APACHE II scores) could be effectively dialysed by SLED, as compared with CRRT. Hemodynamic stability was maintained in the patients on SLED, as none needed switchover to CRRT. The patients undergoing SLED were dialysed during daytime by the haemodialysis nurse, eliminating the need for a specialist nurse in the night. After a median 48 hours of CRRT, it was possible to switch to SLED, resulting in optimal utilization of resources. SLED was much cheaper than CRRT. In a country like India where often there are economical constraints, the judicious use of SLED will help us optimize the need for CRRT.