# Short-Term Renal Replacement Therapy Outcomes of Critically Ill Patients of Acute Kidney Injury and Acute on Chronic Kidney Disease

## TL;DR

This study compares the short-term outcomes of two dialysis methods in critically ill patients with kidney injury, finding that one method has higher mortality but is more cost-effective.

## Contribution

The study provides new insights into the comparative effectiveness of SLED and IHD in AKI patients in a single-center, observational setting.

## Key findings

- Thirty-day mortality was significantly higher in the SLED group compared to the IHD group.
- Vasopressin requirement, mechanical ventilation, and high SOFA scores predicted mortality.
- SLED is a cost-effective option for hemodynamically unstable patients in resource-limited settings.

## Abstract

Background and aims: Sustained low-efficiency dialysis (SLED) is a cost-effective alternative to continuous renal replacement therapy (CRRT) in critically ill acute kidney injury (AKI) patients, in addition to intermittent hemodialysis (IHD) as a mode of renal replacement therapy (RRT) in such patients. This single-center, prospective, observational study aimed to assess the short-term outcomes of SLED and IHD in such patients.

Methodology: Adult (>18 years) patients with AKI requiring dialysis were included from different ICUs of a tertiary care center. Patients were subjected to SLED or IHD according to the standard Kidney Disease: Improving Global Outcomes (KDIGO) 2012 criteria. Treatment duration and ultrafiltration rates were adjusted based on individual patient needs and hemodynamic stability was recorded. Dialysis-free survival, renal function recovery, and mortality rates at one month post discharge were analyzed among all RRT groups.

Results: Out of 128 ICU patients requiring dialysis, 78 underwent SLED, while 43 received IHD. Overall, the mean age was 44.53 years. Patients were predominantly male (53.7%), with common co-morbidities such as hypertension (21.5%) and diabetes mellitus (18.2%). Sepsis (59.2%), hypoperfusion (16.7%), and pregnancy-related AKI (14.16%) were the predominant causes of AKI. Indications for RRT initiation included refractory fluid overload, metabolic acidosis, and refractory hyperkalemia. Patients in the IHD group were relatively younger, had fewer comorbidities, and had more females than those in the SLED group. Thirty-day mortality in the SLED group was significantly higher than that in the IHD group (61.2% versus 20.9%, p < 0.05). Multivariate regression analysis identified vasopressin requirement, mechanical ventilation, and Sequential Organ Failure Assessment (SOFA) scores > 12 as predictors of mortality.

Conclusion: Although IHD is an option of RRT in reasonably stable patients, SLED is also a cost-effective option for hemodynamically unstable AKI patients, particularly in resource-limited settings.