Marshall Mark R, Ma Tianmin, Galler David, Rankin Alan Patrick Nigel, Williams Anthony Brendan
Department of Renal Medicine, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand.
Nephrol Dial Transplant. 2004 Apr;19(4):877-84. doi: 10.1093/ndt/gfg625.
Sustained low-efficiency daily dialysis (SLEDD) is an increasingly popular renal replacement therapy for intensive care unit (ICU) patients. SLEDD has been previously reported to provide good solute control and haemodynamic stability. However, continuous renal replacement therapy (CRRT) is considered superior by many ICU practitioners, due first to the large amounts of convective clearance achieved and second to the ability to deliver treatment independently of nephrology services. We report on a program of sustained low-efficiency daily diafiltration (SLEDD-f) delivered autonomously by ICU nursing personnel, and benchmark solute clearance data with recently published reports that have provided dose-outcome relationships for renal replacement therapy in this population.
SLEDD-f treatments were delivered using countercurrent dialysate flow at 200 ml/min and on-line haemofiltration at 100 ml/min for 8 h on a daily or at least alternate day basis. All aspects of SLEDD-f were managed by ICU nursing personnel. Clinical parameters, patient outcomes and solute levels were monitored. Kt/V, corrected equivalent renal urea clearance (EKRc) and theoretical Kt/V(B12) were calculated.
Fifty-six SLEDD-f treatments in 24 critically ill acute renal failure patients were studied. There were no episodes of intradialytic hypotension or other complications. Observed hospital mortality was 46%, not significantly different from the expected mortality as determined from the APACHE II illness severity scoring system. Electrolyte control was excellent. Kt/V per completed treatment was 1.43+/-0.28 (0.96-2.0). Kt/V(B12) per completed treatment was 1.02+/-0.21 (0.6-1.38). EKRc for patients was 35.7+/-6.4 ml/min (25.0-48.2).
SLEDD-f provides stable renal replacement therapy and good clinical outcomes. Logistic elements of SLEDD-f delivery by ICU nursing personnel are satisfactory. Small solute clearance is adequate by available standards for CRRT and intermittent haemodialysis, and larger solute clearance considerable. SLEDD-f is a viable alternative to CRRT in this setting.
持续性低效每日透析（SLEDD）是一种在重症监护病房（ICU）患者中越来越受欢迎的肾脏替代治疗方法。此前有报道称SLEDD能实现良好的溶质控制和血流动力学稳定性。然而，许多ICU医生认为连续性肾脏替代治疗（CRRT）更具优势，首先是因为其能实现大量的对流清除，其次是能够独立于肾脏科服务进行治疗。我们报告了一项由ICU护理人员自主实施的持续性低效每日透析滤过（SLEDD - f）方案，并将溶质清除数据与最近发表的报告进行了对比，这些报告提供了该人群肾脏替代治疗的剂量 - 结局关系。
SLEDD - f治疗采用每分钟200毫升的逆流透析液流速和每分钟100毫升的在线血液滤过，每天或至少隔天进行8小时。SLEDD - f的所有方面均由ICU护理人员管理。监测临床参数、患者结局和溶质水平。计算Kt/V、校正后的等效肾脏尿素清除率（EKRc）和理论Kt/V（B12）。
对24例重症急性肾衰竭患者进行了56次SLEDD - f治疗。未发生透析中低血压或其他并发症。观察到的医院死亡率为46%，与根据急性生理与慢性健康状况评分系统（APACHE II）疾病严重程度评分确定的预期死亡率无显著差异。电解质控制良好。每次完成治疗的Kt/V为1.43±0.28（0.96 - 2.0）。每次完成治疗的Kt/V（B12）为1.02±0.21（0.6 - 1.38）。患者的EKRc为35.7±6.4毫升/分钟（25.0 - 48.2）。
SLEDD - f提供了稳定的肾脏替代治疗和良好的临床结局。ICU护理人员实施SLEDD - f的后勤要素令人满意。按照CRRT和间歇性血液透析的现有标准，小分子溶质清除足够，大分子溶质清除可观。在这种情况下，SLEDD - f是CRRT的可行替代方案。
