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Sustained Low-Efficiency Dialysis (SLED)

Overview

Sustained Low-Efficiency Dialysis (SLED) is a renal replacement therapy (RRT) used for patients with acute kidney injury (AKI) or end-stage renal disease (ESRD), particularly in critical care settings. It is an alternative to conventional intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). SLED combines the benefits of both modalities by offering gradual fluid and solute removal over a prolonged period (6–12 hours). It is preferred in hemodynamically unstable patients as it minimizes abrupt shifts in blood pressure while maintaining efficient clearance of toxins.
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How is SLED done?

Before initiating SLED, the following preparations are necessary:
  • Patient Assessment : Evaluate hemodynamic stability, fluid balance, electrolyte levels, and indications for dialysis.
  • Vascular Access : Common access points include central venous catheters in the internal jugular, subclavian, or femoral veins.
  • Dialysis Machine Setup : Ensure availability of a suitable dialysis machine compatible with SLED, with appropriate settings for flow rates and duration.
  • Anticoagulation : Heparin or citrate anticoagulation is used to prevent clotting of the extracorporeal circuit.
  • Dialysate and Replacement Fluids : Selection is based on the patient’s metabolic and electrolyte status.
  • Monitoring Equipment : Blood pressure, heart rate, oxygen saturation, and laboratory parameters should be continuously monitored.

CPR involves two main components:
  • SLED is conducted in an intensive care setting under continuous monitoring. It employs lower blood and dialysate flow rates compared to traditional hemodialysis but operates for a longer duration.
  • The gradual removal of fluids and toxins helps in maintaining cardiovascular stability while effectively managing electrolyte imbalances.

    Patient Positioning: Ensure the patient is in a comfortable position with proper vascular access.
  • Machine Connection : Connect the extracorporeal circuit to the patient’s vascular access site.
  • Prime the System : Flush the dialysis tubing with saline or heparinized saline to remove air and prevent clot formation.
  • Set Parameters : Adjust blood flow rate (100–200 mL/min), dialysate flow rate (200–300 mL/min), and ultrafiltration rate according to the patient's needs.
  • Initiate Dialysis : Start the dialysis process while continuously monitoring vital signs and laboratory parameters.
  • Adjustments During Dialysis : Modify ultrafiltration rates based on fluid balance and hemodynamic response.
  • Completion and Disconnection : After the session (typically 6–12 hours), the patient is disconnected from the machine, and vascular access is secured.
  • Post-Dialysis Monitoring : Assess for hypotension, electrolyte imbalances, and other complications.

    While SLED is considered a safer alternative for critically ill patients, certain complications may arise:
  • Hypotension: Due to fluid removal, although less frequent than in conventional dialysis.
  • Electrolyte Imbalances : Sudden shifts can lead to hypokalemia or hyperkalemia.
  • Thrombosis or Bleeding : Related to anticoagulation use.
  • Infections : Risk of catheter-related bloodstream infections.
  • Muscle Cramps : Caused by rapid fluid shifts.
  • Acid-Base Disorders : Metabolic acidosis or alkalosis may occur if dialysate composition is not optimized.
What are the benefits SLED?
  • Hemodynamic Stability : SLED provides gradual fluid and solute removal, reducing hypotension risk.
  • Better Clearance of Toxins : Compared to intermittent dialysis, it offers efficient clearance while preventing rebound phenomena.
  • Flexibility in ICU Settings : Can be scheduled during off-peak hours and adapted to the patient’s hemodynamic status.
  • Lower Costs : More affordable than CRRT, making it a viable option in resource-limited settings.
  • Less Need for Continuous Monitoring : Unlike CRRT, SLED does not require 24-hour supervision, reducing nursing workload.

Infrastructure & Facilities

Hospitals offering SLED must have:
  • ICU Setup : Equipped with dialysis-compatible beds, vital monitoring systems, and emergency resuscitation equipment.
  • Dialysis Machines : Capable of prolonged low-efficiency therapy.
  • Dedicated Dialysis Unit : Trained staff, sterile environment, and readily available consumables (dialyzers, tubing, anticoagulants, and dialysate solutions).
  • Laboratory Support : Frequent monitoring of electrolytes, blood gases, and renal function parameters.
  • Pharmacy and Anticoagulation Monitoring : Close collaboration with pharmacists to optimize anticoagulant use and minimize complications.
Associated Doctors
  • Nephrologists : Oversee the dialysis prescription and patient management.
  • Intensivists : Ensure hemodynamic stability and address critical care needs.
  • Dialysis Nurses : Operate the dialysis machine and monitor patients.

FAQs

SLED is recommended for critically ill patients with AKI or ESRD who cannot tolerate rapid fluid removal due to cardiovascular instability.

Typically, 6–12 hours depending on the patient’s clinical status.

Yes, to prevent clot formation in the dialysis circuit. Heparin or citrate anticoagulation is commonly used.

SLED is conducted intermittently for 6–12 hours,

whereas CRRT runs continuously for 24 hours. SLED is more cost-effective and requires less intensive monitoring.

Generally, SLED is conducted in the ICU due to the need for continuous monitoring, but it may be performed in specialized dialysis units if adequate support is available.

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Website Design and Development by Sterco Digitex

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