Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, India.
Akron Nephrology Associates, Cleveland Clinic Akron General, Akron, Ohio, USA.
Hemodial Int. 2023 Jul;27(3):308-317. doi: 10.1111/hdi.13088. Epub 2023 Apr 25.
Continuous kidney replacement therapy (CKRT) is the preferred modality in critically ill children with acute kidney injury. Upon improvement, intermittent hemodialysis is usually initiated as a step-down therapy, which can be associated with several adverse events. Hybrid therapies such as Sustained low-efficiency daily dialysis with pre-filter replacement (SLED-f) combines the slow sustained features of a continuous treatment, ensuring hemodynamic stability, with similar solute clearance along with the cost effectiveness of conventional intermittent hemodialysis. We examined the feasibility of using SLED-f as a transition step-down therapy after CKRT in critically ill pediatric patients with acute kidney injury.
A prospective cohort study was conducted in children admitted to our tertiary care pediatric intensive care units with multi-organ dysfunction syndrome including acute kidney injury who received CKRT for management. Those patients receiving fewer than two inotropes to maintain perfusion and failed a diuretic challenge were switched to SLED-f.
Eleven patients underwent 105 SLED-f sessions (mean of 9.55 +/- 4.90 sessions per patient), as a part of step-down therapy from continuous hemodiafiltration. All (100%) our patients had sepsis associated acute kidney injury with multiorgan dysfunction and required ventilation. During SLED-f, urea reduction ratio was 64.1 +/- 5.3%, Kt/V was 1.13 +/- 0.1, and beta-2 microglobulin reduction was 42.5 +/-4%. Incidence of hypotension and requirement of escalation of inotropes during SLED-f was 18.18%. Filter clotting occurred twice in one patient.
SLED-f is a safe and effective modality for use as a transition therapy between CKRT and intermittent hemodialysis in children in the PICU.
连续肾脏替代疗法（CKRT）是治疗伴有急性肾损伤的危重症儿童的首选方法。在病情改善后，通常会开始间歇性血液透析作为降阶梯治疗，但这可能会导致多种不良事件。SLED-f（带预滤器更换的持续低效率每日透析）等混合疗法结合了连续治疗的缓慢持续特性，确保了血流动力学的稳定性，同时具有与传统间歇性血液透析相当的溶质清除率和成本效益。我们研究了 SLED-f 在伴有急性肾损伤的危重症儿科患者中作为 CKRT 后降阶梯治疗的可行性。
对入住我院三级儿童重症监护病房的多器官功能障碍综合征伴急性肾损伤并接受 CKRT 治疗的患儿进行前瞻性队列研究。对接受维持灌注的少于两种正性肌力药物且利尿剂试验失败的患者转换为 SLED-f。
11 例患者接受了 105 次 SLED-f 治疗（每位患者平均 9.55 +/- 4.90 次），作为连续性血液透析滤过降阶梯治疗的一部分。我们所有患者（100%）均患有脓毒症相关性急性肾损伤和多器官功能障碍，需要通气。在 SLED-f 期间，尿素清除率为 64.1 +/- 5.3%，Kt/V 为 1.13 +/- 0.1，β-2 微球蛋白清除率为 42.5 +/-4%。SLED-f 期间低血压的发生率和正性肌力药物升级的需求为 18.18%。有 1 例患者的过滤器发生了 2 次凝血。
SLED-f 是一种安全有效的方法，可作为儿童重症监护病房中 CKRT 和间歇性血液透析之间的过渡治疗。
