Standard intermittent haemodialysis (IHD) has significant shortcomings in the treatment of the acute renal failure (ARF) in critical illness. These shortcomings relate to haemodynamic instability, the need to remove excess fluid over a short period of time, the episodic nature of small solute control, the limited ability to achieve middle molecular weight solute control and the episodic nature of acid-base control. These shortcomings have stimulated the evolution and increased application of continuous renal replacement therapy (CRRT). CRRT provides major biochemical, biological and physiological advantages over IHD, although it remains unclear whether such advantages translate into clinically important benefits. CRRT, however, is technically demanding, requires supervision 24 hours/day and is often associated with the need for continuous anticoagulation, which, in some patients might be undesirable. In some institutions, CRRT changes the nurse-to-patient ratio from 1:2 to 1:1, an alteration which has major cost implications and which might affect resource availability for other patients. Accordingly, techniques that straddle IHD and CRRT may offer 'best value' in the management of ARF in ICU. Growing information is now being obtained on the efficacy of these so-called 'hybrid techniques' in the ICU. This paper focuses on the practical issues surrounding use of sustained low-efficiency dialysis (SLED).
|Number of pages||11|
|Journal||International Journal of Intensive Care|
|Publication status||Published - 1 Dec 2002|