OBJECTIVES:
To evaluate use of sustained low efficiency dialysis (SLED) in critically ill children with acute kidney injury in a resource-limited setting.
DESIGN:
Observational database cohort study (December 2016 to January 2020).
SETTING:
PICU of a tertiary hospital in India.
PATIENTS:
Critically ill children undergoing SLED were included in the study.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Demographic and clinical data, prescription variables, hemodynamic status, complications, kidney, and patient outcomes of all children undergoing SLED in the PICU were analyzed. A total of 33 children received 103 sessions of SLED. The median (interquartile range, IQR) age and weight of children who received SLED were 9 years (4.5–12.8 yr) and 26 kg (15.2–34 kg), respectively. The most common diagnosis was sepsis with septic shock in 17 patients, and the mean (±sd) Pediatric Risk of Mortality III score at admission was 11.8 (±6.4). The median (IQR) number and mean (±sd) duration of inotropes per session were 3 hours (2–4 hr) and 96 (±82) hours, respectively. Of 103 sessions, the most common indication for SLED was oligoanuria with fluid overload and the need for creating space for fluid and nutritional support in 45 sessions (44%). The mean (±sd) duration of SLED was 6.4 (±1.3) hours with 72 of 103 sessions requiring priming. The mean (±sd) ultrafiltration rate per session achieved was 4.6 (±3) mL/kg/hr. There was significant decrease in urea and creatinine by end of SLED compared with the start, with mean change in urea and serum creatinine being 32.36 mg/dL (95% CI, 18.53–46.18 mg/dL) (p < 0.001) and 0.70 mg/dL (95% CI, 0.35–1.06 mg/dL) (p < 0.001), respectively. Complications were observed in 44 of 103 sessions, most common being intradialytic hypotension (21/103) and bleeding at the catheter site (21/103). Despite complications in one third of the sessions, only nine sessions were prematurely stopped, and 23 of 33 patients receiving SLED survived.
Conclusion:
In critically ill children, our experience with SLED is that it is feasible and provides a viable form of kidney replacement therapy in a resource-limited setting.
