Sustained Low-Efficiency Daily Diafiltration for Diabetic Nephropathy Patients with Acute Kidney Injury

Abstract

Objective: To investigate the efficacy, safety and cost of treating patients with acute kidney injury (AKI) and diabetic nephropathy (DN) with continuous renal replacement therapy (CRRT) or sustained low-efficiency daily diafiltration with hemofiltration (SLEDD-f). Subjects and Methods: Medical records of patients with AKI/DN from January 2006 to December 2012 were reviewed. Fifty-five patients who received CRRT and 52 who received SLEDD-f were included in the study. CRRT and SLEDD-f were performed for 20-72 h per session and 8-10 h per session, respectively. Mortality and renal function recovery rates were evaluated 30 days after the initiation of renal replacement therapy (RRT) and APACHE-II and SOFA scores, anticoagulant dose, inflammatory indices and cost were calculated at baseline and at the end of RRT. Results: Of the 55 patients treated with CRRT, 49 (89.1%) had a 30-day survival rate and 30 (54.5%) had a 30-day renal recovery rate. Of the 52 patients with SLEDD-f, these rates were 92.3% (n = 48) and 61.5% (n = 32), respectively. The dosage of low-molecular-weight heparin in the CRRT and SLEDD-f groups was 15,230 ± 1,460 and 6,320 ± 490 U/day, respectively. The cost of hemopurification and the total cost for patients treated with CRRT was CNY 28,628 ± 5,576 (USD 4,210 ± 820) and CNY 38,828 ± 6,324 (USD 5,710 ± 930), respectively. These were higher than those for patients treated with SLEDD-f at CNY 13,260 ± 1,564 (USD 1,950 ± 230) and CNY 19,720 ± 2,652 (USD 2,900 ± 390), respectively. Conclusions: SLEDD-f offered a similar chance of renal recovery and also had further advantages such as a lower heparin dosage, a shorter therapy time and lower hospitalization costs for patients than CRRT. Studies with larger, randomized sample sizes are needed to confirm these findings.

Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis

“…Third, although we extracted data for mortality at the end of follow-up, the duration of each study varied from 10 days in 1 study 6 to 30 days in 6 studies 7,9,[19][20][21]28 to 90 days in 2 studies, 8,27 or to ICU mortality in 1 study 30 and in-hospital mortality in 6 studies. [22][23][24][25][26]29 Even so, although end points of different follow-up periods could modify the absolute risk, they should not bias the overall RR.…”

“…28 All results indicated that costs were lower with EDD compared to CRRT. Metaanalysis could not be estimated due to absence of a standard deviation.…”

“…Six studies were from Asia; 4, North America; 4, Europe; 2, Oceania; and 1, Africa. A variety of outcomes were recorded in these studies, including mortality (16 studies), 6-9,19-30 kidney recovery (7 studies), 7,9,19,21,22,28,29 fluid removal (9 studies), 6-8,18,19, 6,19,26 Among these studies, the duration of EDD was 6.0 to 14.9 hours per day, which was lower than CRRT (18.0-23.5 hours per day). Characteristics of the RCTs and observational studies fulfilling the inclusion criteria are listed in Table 1 and Item S2.…”

Sustained low-efficiency extended dialysis (SLED) with single-pass batch system in critically-ill patients with acute kidney injury (AKI)

“…In all but five of these sessions, pre-session MAP was \65 mmHg. Hypotension was associated with higher presession levels of lactate (22 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] vs. 18 [13][14][15][16][17][18][19][20][21][22][23][24] Table 2. Also, hypotension was more frequent in clinical than in surgical ICUs (26 vs. 17 %, p = 0.03).…”

Effect of renal replacement therapy modalities on renal recovery and mortality for acute kidney injury: A PRISMA‐compliant systematic review and meta‐analysis

“…Table indicated the characteristics of all included studies. Lastly, the study included 11 articles for comparison between AKI patients treated with CRRT and IHD, 10‐12,14‐21 eight articles for comparison between AKI patients treated with CRRT and SLED, 8,9,22‐26 and three articles 27‐29 for comparison between AKI patients treated with CRRT and IRRT (which kind of IRRT was not clear), respectively. For comparison between AKI patients treated with CRRT and IHD, these studies included totally 42 079 AKI patients given CRRT and 19 154 patients given IHD.…”