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Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open Access

Comparison between sustained low-efficiencydialysis (SLED) and continuous renal replacement therapy (CRRT) in patients of septic shock: a randomized controlled trial

  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Intensive Care Medicine Experimental20153 (Suppl 1) :A55

https://doi.org/10.1186/2197-425X-3-S1-A55

  • Published:

Keywords

  • Septic Shock
  • Vasopressin
  • Dobutamine
  • Acute Kidney Injury
  • Continuous Renal Replacement Therapy

Introduction

Acute Kidney Injury is common in patients of septic shock. There is sparse data comparing SLED and CRRT in septic shock patients.

Objectives

Compare the hemodynamic stability and outcome of SLED vs. CRRT in septic shock patients.

Methods

Prospective randomized study in a 12 bedded medical ICU. After clearance from institutes ethics committee and taking informed consent from the relatives 40 adult patients in septic shock who were to undergo dialysis for Acute Kidney Injury were included in the study. They were randomly assigned to SLED or CRRT group. They underwent the same modality of dialysis until they were hemodynamically stable. Study was done with an Intention to treat. Hemodynamic instability was defined as an increase in vasopressor dependency > 20 mmHg-1 from the pre dialysis value. Vasopressor index was calculated by the formula (dopamine dose×1) + (dobutamine dose×1) + (adrenaline dose×100) + (noradrenaline dose×100) + (vasopressin dose×10).The doses were in microgram/kg/min for all vasopressors except vasopressin which is in Units/hour. The Vasopressor dependency was calculated by the formula (Vasopressor index/MAP) X 100. The worst value of vasopressor dependency during the dialysis session was taken into consideration. The primary objective was 28 day mortality. The secondary objective was hemodynamic stability during the dialysis sessions. The Statistical analysis was done by SPSS 17. Mann Whitney test was done for continuous data and Fishers Exact test was done for proportions. Survival analysis was done by Kaplan Mayer method with log rank test.

Results

The study was conducted from June 2014 to January 2015. The two groups were comparable in terms of age, sex, APACHE II & SOFA (p > 0.05).(Table 1) Pre dialysis vasopressor dose, BUN, Creatinine, Vasopressor index, Vasopressor dependency, & base deficit were also comparable (p > 0.05). (Table 2) The 28 day mortality rate was 75% (15/20) in CRRT group and 65% (13/20) in SLED group. The log rank estimate was 0.64 for mortality. The hemodynamic instability as defined by vasopressor dependency was 54% (13/24) in CRRT group while in SLED group it was 60% (27/45) (p= 0.50).(Table 3)
Table 1

Demographics.

 

SLED (n = 20) Median(IQR)

CRRT (n = 20) Median (IQR)

p value

Age (years)

54 (29 - 60)

47 (24 - 62)

0.85

Sex (male)-n (%)

15 (75%)

12 (60%)

0.50

APACHE II

25 (20 - 28)

28 (22 - 29)

0.35

SOFA

13 (10 - 15)

14 (12 - 18)

0.09

Table 2

Characteristics at the time of Randomization.

 

SLED (n = 20) Median(IQR)

CRRT (n = 20) Median (IQR)

p value

Creatinine (mg/dl)

2.5 (1.5 - 4.1)

3 (1.4 - 4.5)

0.90

BUN (mg/dl)

71 (53 - 100)

46 (37 - 125)

0.54

MAP (mmHg)

81 (70 - 87)

78 (73-99)

0.45

Dose of Noradrenaline

0.3 (0.21-0.61)

0.35 (0.3 - 0.75)

0.56

Bicarbonate (mmol/L)

18 (14 - 23)

16 (14 - 18)

0.68

Base deficit

8 (3 - 11)

12 (5-13)

0.10

Vasopressor Index

50 (43 - 84)

62 (52 -104)

0.14

Vasopressor Dependency

64 (45 - 105)

75 (55 - 98)

0.42

Table 3

Outcome.

 

SLED (n = 20) Median(IQR)

CRRT (n = 20) Median (IQR)

p value

Mortality (Day 28)

13/20 (65%)

15/20 (75%)

0.64

Length of stay (in ICU)

13.5 (5 - 30)

12 (6 - 25)

0.73

Hemodynamic unstable sessions

27/45 (60%)

13/24 (54%)

0.50

Conclusions

SLED is comparable to CRRT in septic shock patients and can be used as an alternative modality of RRT. Larger RCTs are needed to confirm the above finding.

Authors’ Affiliations

(1)
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Critical Care Medicine, Lucknow, India

References

  1. Baldwin I, Naka T, Koch B, Fealy N, Bellomo R: A pilot randomised controlled comparison of continuous veno-venous haemofiltration and extended daily dialysis with filtration: effect on small solutes and acid-base balance. Intensive Care Med. 2007, 33 (5): 830-5. 10.1007/s00134-007-0596-0. MayPubMedView ArticleGoogle Scholar
  2. Cruz DN, Antonelli M, Fumagalli R, et al: Early Use of Polymyxin B Hemoperfusion in Abdominal Septic Shock: The EUPHAS Randomized Controlled Trial. JAMA. 2009, 301 (23): 2445-2452. 10.1001/jama.2009.856.PubMedView ArticleGoogle Scholar

Copyright

© Mishra et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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