Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 5 ( May, 2017 ) > List of Articles


A pilot randomized controlled trial of comparison between extended daily hemodialysis and continuous veno-venous hemodialysis in patients of acute kidney injury with septic shock

Arvind Kumar Baronia, Ratendra Kumar Singh

Keywords : Acute kidney injury, dialysis, septic shock

Citation Information : Baronia AK, Singh RK. A pilot randomized controlled trial of comparison between extended daily hemodialysis and continuous veno-venous hemodialysis in patients of acute kidney injury with septic shock. Indian J Crit Care Med 2017; 21 (5):262-267.

DOI: 10.4103/ijccm.IJCCM_85_17

License: CC BY-ND 3.0

Published Online: 01-05-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Aim of Study: Acute kidney injury (AKI) is common in patients of septic shock. There is sparse data comparing sustained low-efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in patients with septic shock. Materials and Methods: This is a prospective randomized study in a 12-bedded medical intensive care unit. After clearance from institute′s ethics committee and obtaining informed consent from the relatives, sixty adult patients with septic shock who were to undergo dialysis for AKI were included in the study. They were randomly assigned to SLED or CRRT group. Hemodynamic instability was defined as in terms of vasopressor dependency (VD). The worst value of VD during the dialysis session was taken into consideration. The primary objective was look at hemodynamic changes and secondarily into the efficacy. Results: The demographic data were comparable between the sixty patients randomized to thirty in each group. Delta VD and delta vasopressor index (DVI) were similar in SLED group compared to the CRRT group. CRRT group had better efficacy in terms of both equivalent renal urea clearance though fluid balance was not significantly better in CRRT group. Conclusion: SLED is a viable modality of renal replacement therapy in patients with septic shock as the hemodynamic effects are similar to CRRT.

PDF Share
  1. Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the Intensive Care Unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 1998;66:S16-24.
  2. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;1:1-138.
  3. Neves JB, Rodrigues FB, Castelão M, Costa J, Lopes JA. Extended daily dialysis versus intermittent hemodialysis for acute kidney injury: A systematic review. J Crit Care 2016;33:271-3.
  4. Zhang L, Yang J, Eastwood GM, Zhu G, Tanaka A, Bellomo R. Extended daily dialysis versus continuous renal replacement therapy for acute kidney injury: A meta-analysis. Am J Kidney Dis 2015;66:322-30.
  5. Ostermann M, Chang RW. Acute kidney injury in the Intensive Care Unit according to RIFLE. Crit Care Med 2007;35:1837-43.
  6. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA 2005;294:813-8.
  7. Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr., Hanley FL, Hickey PR, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995;92:2226-35.
  8. Zuppa AF, Nadkarni V, Davis L, Adamson PC, Helfaer MA, Elliott MR, et al. The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function. Crit Care Med 2004;32:2318-22.
  9. Mishra SB, Singh RK, Baronia AK, Poddar B, Azim A, Gurjar M. Sustained low-efficiency dialysis in septic shock: Hemodynamic tolerability and efficacy. Indian J Crit Care Med 2016;20:701-7.
  10. Cruz DN, Antonelli M, Fumagalli R, Foltran F, Brienza N, Donati A, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: The EUPHAS randomized controlled trial. JAMA 2009;301:2445-52.
  11. Casino FG, Marshall MR. Simple and accurate quantification of dialysis in acute renal failure patients during either urea non-steady state or treatment with irregular or continuous schedules. Nephrol Dial Transplant 2004;19:1454-66.
  12. Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev 2007;3:CD003773.
  13. Kielstein JT, Schiffer M, Hafer C. Back to the future: Extended dialysis for treatment of acute kidney injury in the Intensive Care Unit. J Nephrol 2010;23:494-501.
  14. Fieghen HE, Friedrich JO, Burns KE, Nisenbaum R, Adhikari NK, Hladunewich MA, et al. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury. BMC Nephrol 2010;11:32.
  15. Baldwin I, Bellomo R, Naka T, Koch B, Fealy N. A pilot randomized controlled comparison of extended daily dialysis with filtration and continuous veno-venous hemofiltration: Fluid removal and hemodynamics. Int J Artif Organs 2007;30:1083-9.
  16. Marshall MR, Golper TA, Shaver MJ, Alam MG, Chatoth DK. Urea kinetics during sustained low-efficiency dialysis in critically ill patients requiring renal replacement therapy. Am J Kidney Dis 2002;39:556-70.
  17. Silversides JA, Hladunewich MA, Lapinsky SE, Pinto R, Kuint R, Wald R, et al. Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: A cohort study. Crit Care 2014;18:624.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.