Hi, working in a resource limited setting, we have had the unfortunate need to withdraw dialysis to a lot of patients presenting wit hemodynamic instability due to economic constraints and non affordability for cvvhdf. We were contemplating if we could run slow hemodiafiltration using the conventional HD machine with slight modification of the settings. would it be reasonable and effective idea to implement the same ? and have there been any previous such attempts ?
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Accepted AnswerPaul PalevskyThat is the concept of prolonged intermittent renal replacement therapy (PIRRT), also known as sustained low-efficiency dialysis (SLED) or extended duration dialysis (EDD). Using a conventional hemodialysis machine, the dialysate flow rate is reduced to between 100 mL/min and 300 mL/min (depending on the machine) and the duration of treatment is extended, usually to between 8 and 16 hours. PIRRT using slow hemodiafiltration has been well described as sustained low-efficiency daily diafiltration (SLEDD-f), although there are no data to suggest that convective clearance in this setting provides improved outcomes as compared to diffusive therapies (just as there are no data to support improved outcomes with CVVH or CVVHDF as compared to CVVHD). The technique was well described by Mark Marshall and colleagues from New Zealand more than a decade ago ((Marshall MR, et al. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy.Nephrol Dial Transplant. 2004 Apr;19(4):877-84); I have attached a link to the PDF of the manuscript to this post.