ESPN 50th Annual Meeting

ESPN 2017


 
Feasibility and tolerability of sustained low efficiency dialysis (SLED) in critically sick pediatric patients: A multicentric retrospective study
RAJIV SINHA 1 SIDHARTH SETHI 2 ARPANA IYENGAR 3 VALENTINE LOBO 4

1- INSTITUTE OF CHILD HEALTH, KOLKATA
2- MEDANTA , GUARGAON, INDIA
3- ST JOHNS HOSPITAL, BANGALURU
4- KEM, PUNE
 
Introduction:

 

Sustained low-efficiency dialysis (SLED) has emerged as an alternative to CRRT in the management of hemodynamically unstable adult patients with AKI. This was a retrospective record review from three major centres in the country from Jan 2010 to June 2016. This is the largest ever data on Pediatric SLED published till date. The objective of the study was to document the SLED practices in these centres, and to look at the feasibility and tolerability of SLED in critically sick pediatric patients.

 

Material and methods:

 All pediatric patients undergoing SLED in the collaborating centres were included in the study and the basic demographic data, prescription parameters and outcomes were recorded.

Results:

  From January 2010 to June 2016, a total of 68 children received 211 sessions of SLED at three major centres in the country. PRISM score at admission in patients was 13.33+9.15. Fifty seven patients were ventilated (84%). Most of the patients had one more organ system involved in addition to renal (n=64; 94%). Heparin free sessions were done in 153 sessions (72%). There was no statistical change in mean blood pressure in all patients before or after sessions of SLED. Though there was no statistical difference in oxygenation index of patients pre and post SLED, there was an improvement in serum bicarbonate. Premature terminations had to be done in 27 sessions (13% of all sessions), out of which 7 sessions had to be terminated due to circuit clotting (3.3%). Intradialytic Hypotension or need for more ionotrope escalation was seen 31 sessions out of which terminations were done in 20 sessions. Twenty nine patients died due to sepsis and MODS.(Table 1)

Table 1 - Patient characteristics by survival status

Parameters

Value (68 patients; 211 sessions)

Premature session termination

27 (13%)

Sessions with temperature alteration

7 (3.3%)

Pre SLED mean BP (mm of Hg)

82.31±13.76

Post SLED mean BP (mm of Hg)

80.81±14.54

Pre SLED mean number of inotropes

1.19±1.25

Post SLED mean number of inotropes

1.16±1.25

Pre SLED bicarbonate (mg/dl)

17.85±4.64*

Post SLED bicarbonate (mg/dl)

21.19±3.78*

Post SLED hypophosphatemia (sessions;%)

6 (3%)

Post SLED hypokalemia (sessions;%)

59 (28%)

Pre SLED oxygenation index [n=61 patients]

14.56±5.91

Post SLED oxygenation index [n=61 patients]

11.75±6.45

*p<0.05

 

 

Conclusions:

 

SLED appears to be a feasible and also tolerable method of providing renal replacement in critically ill pediatric patients