Sustained Low-Efficiency Dialysis Versus Intermittent Hemodialysis in Critically Ill Patients with Severe Acute Kidney Injury

Why clinicians should know about it

• Picked for Nephrology (paper of the day, 8 September 2026): SLED vs IHD improves hemodynamic stability in AKI

Abstract

OBJECTIVE: The objectives of the study were to compare clinical efficacy, hemodynamic stability, and 90-day renal outcomes between Sustained low-efficiency dialysis (SLED) and Intermittent hemodialysis (IHD) in Medical intensive care unit (MICU) patients with severe Acute kidney injury (AKI). METHODS: This observational cohort study evaluated 300 patients with KDIGO Stage-2 or 3 AKI (SLED: n = 160; IHD: n = 140). Outcomes included MICU mortality, discharge renal recovery, stay duration, intradialytic complications, and 90-day renal preservation. RESULTS: Baseline characteristics were comparable. No significant differences emerged between SLED and IHD regarding MICU mortality (33% vs. 39%, p = 0.272) or renal recovery at discharge (61% vs. 54%, p = 0.223). However, SLED demonstrated superior safety, significantly lowering intradialytic hypotension (21% vs. 41%, p < 0.001) and the need for new vasopressors (11% vs. 22%, p = 0.011), while minimizing mean arterial pressure drops (12.12 ± 3.9 vs. 19 ± 6.36 mmHg, p < 0.001). SLED achieved shorter median MICU stays (14 vs. 16 days, p < 0.001). At 90-day, SLED survivors exhibited significantly lower Renal replacement therapy (RRT) dependence (11% vs. 24%, p = 0.014), reduced chronic kidney disease progression (26% vs. 34%, p = 0.044), and higher glomerular filtration rate (eGFR) (55.93 ± 7.69 vs. 45.86 ± 9.29 mL/min/1.73m2, p < 0.001). CONCLUSIONS: While short-term mortality is similar, SLED dramatically mitigates intradialytic hemodynamic instability compared to IHD. By minimizing circulatory insults, SLED significantly improves 90-day parenchymal renal recovery and minimizes long-term dialysis dependence among AKI survivors.

Abstract as published, via PubMed.