SUSTAINED LOW-EFFICIENCY DAILY DIALYSIS (SLEDD)

Renal Sciences | Posted on 05/12/2020 by RBH

Sustained low-efficiency daily dialysis (SLEDD) is a very widely accepted renal replacement therapy for patients in the intensive care unit suffering from critically ill severe renal failure. This method is a therapeutic improvement of the continuous renal replacement therapy (CRRT) and intermittent haemodialysis (IHD) methods; this method combines the desirable properties of both methods including:

• Reduced rate of ultra filtration to ensure optimized flow of blood through the cardiovascular system
• Minimises chances of solute misbalance by removing solute through low-efficiency method
• Maximises daily dose of dialysis that helps in sustaining treatment
• Easy access to patient for various out-of-unit diagnostic and therapeutic procedures

SLEDD mainly aims to minimize hemodynamic perturbations that occur during intermittent hemodialysis for patients suffering from acute kidney injury and hemodynamic instability. This procedure uses normal hemodialysis machines to provide extended duration of renal replacement therapy. This method was introduced in 2007 as an alternative treatment to Continuous Renal Replacement Therapies (CRRT) that involves dialysis treatment on a continuous 24-hour per day. The latter therapy proved very expensive and also has problems with anticoagulation, which are all not present in SLEDD. SLEDD is a reasonable treatment that can be readily performed with no anticoagulation. This new form of treatment has been increasingly adopted by doctors across the world to treat patients with acute kidney injury and hemodynamic instability.

Some of the basic advantages of SLEDD over other similar treatment methods include:

• Effective clearance of small solutes
• Enhanced hemodynamic tolerability
• Flexible treatment schedules
• Flexibility of intensity
• Reduced treatment costs

Over the years, SLEDD has emerged as a better hybrid of Continuous Renal Replacement Therapies (CRRT) and Intermittent Hemodialysis (IHD). This treatment method combines the desirable properties of both methods to provide the best results. Moreover, with recent advancements, SLEDD is preferred as an efficient and convenient renal replacement therapy for patients that are not considered appropriate for IHD. SLEDD has made it possible to achieve ultra filtration goals in patients that are hypotensive or inotrope dependent. However, for a patient being treated by SLEDD treatment, electrolytes should be closely monitored to avoid any complications.

That said, for a patient to be considered for SLEDD, he/she must be unsuitable for other standard therapies. Some conditions in which SLEDD is highly recommended are:

• Patients with a risk of disequilibrium, such as people with urea levels of more than 50mmol/l, etc.
• Patients that are beyond a certain age
• Patients with pre-existing CNS disease
• Patients that have cardiovascular problems or are on the borderline for cardiovascular stability
• Patients that have excessive fluid or are nephrotic
• Patients that need inotropic support

In all, SLEDD is a very effective method as compared to other treatment methods of acute kidney disease, such as Continuous Renal Replacement Therapies (CRRT) and Intermittent Hemodialysis (IHD). Over the years, SLEDD has proven to be very advantageous in treating patients that have high instability and are hypeotensive. The SLEDD method is an ultimate combination of the best of both therapies that aims to save more lives. It is been increasing adopted for sever case patients who do not qualify for other treatment methods.