Sustained Low-Efficiency Dialysis
Sustained low-efficiency dialysis (SLED) is a new technique that is described as an alternative to intermittent hemodialysis (IHD) and CRRT. In the ICU setting, various factors may hamper effective toxin removal using these traditional therapies. IHD is often complicated by hypotension as well as inadequate solute and fluid removal; whereas CRRT is associated with higher complexity, increased nursing requirements, continuous anticoagulation, and higher expenses for specialized equipment and customized solutions.
SLED combines the advantages of both IHD and CRRT by using conventional hemodialysis machines at slower blood flow rates (Qb ≈200 mL/min), reduced dialysate flow rates (Qd ≈300–350 mL/min) for prolonged periods (Td ≈8–12 hours) on a daily basis.
In hemodynamically unstable, critically ill patients SLED is better tolerated, results in high solute clearance and fluid removal, and does not entail the same level of complexity or costs associated with continuous therapies.
Although there is mounting evidence to support the use of SLED in the ICU, it remains a novel extracorporeal treatment modality for which specific studies addressing its efficacy in acute poisonings (e.g., salicylate toxicity) remain anecdotal.