Abstract

NEUENFELDT, Tino  and  HOPF, Hans-Bernd. Sustained low efficiency dialysis as standard renal replacement therapy in an interdisciplinary intensive care unit - A five year cost-benefit analysis. Rev. colomb. anestesiol. [online]. 2013, vol.41, n.2, pp.88-96. ISSN 0120-3347.  https://doi.org/10.1016/j.rca.2013.01.002.

Background: Sustained low efficiency dialysis (SLED) as primary renal replacement therapy (RRT) in acute kidney injury (AKI) is not widely used, despite substantial economic advantages. We evaluated costs and outcome in a 5 year retrospective study on our ICU. Methods: From 2006 to 2010 we selected all patients with the ICD-10 codes N17 and N18 who were treated with SLED on our ICU. Patients with a stay <2 days, an extra-renal indication for dialysis or chronic dialysis were excluded. Variables: number of SLEDs, duration of ICU and hospital stay, ICU and hospital mortality, SAPS II, TISS 28, blood urea and creatinine, C-reactive protein, mechanical ventilation, diagnoses. Long-term outcome was evaluated by sending all discharged patients a questionnaire. Results: Between 2006 and 2010, 3247 SLED-treatments in 421 patients (mean SAPS II: 41 points without GCS) were performed. ICU and hospital mortality in the patients treated only with SLED (n = 392) was 34% and 45%, respectively. 71% of all surviving patients had good quality of life and 12% of all discharged patients still needed dialysis. Total costs for SLED were 526.819 € and total proceeds were 734.996 €. Assuming also 3247 «CWHDF-days» for cost comparisons we calculated costs of 729.991 € with proceeds of 690.864 € for CVVHDF. Conclusions: In critically ill patients with AKI SLED is an effective RRT, with short- and long-term outcome being comparable to outcome data with CVVHDF. Based on our cost-proceeds analysis SLED seems to be the preferable renal replacement therapy.

Keywords : Acute Kidney Injury; Dyalisis; Efficiency; Intensive Care; Renal Replacement Therapy.

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