Sustained Low Effectivity Dialysis – ppt video on-line obtain

Sustained Low Efficiency Dialysis
July 3, 2017 0 Comments

Presentation on theme: “Sustained Low Effectivity Dialysis”— Presentation transcript:

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Sustained Low Effectivity Dialysis
Dr Sidharth Kumar Sethi Pediatric Nephrology Kidney and Urology Institute Medanta-The Medicity INDIA

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Define Want for SLED? Technical Points Drug & Vitamin clearance
Present accessible proof Adults Youngsters Price Issues Execs & Cons

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CRRT Cons! Price Complexities Preliminary specialised equipment
Working value of strains & filters Substitute fluid Complexities Procedural Elevated workload for already busy ICU nurses! Surprising interruptions

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SLED Decrease solute clearance
maintained for longer durations of time (not essentially steady) Hybrid therapies Extended intermittent renal substitute remedy (PIRRT) Prolonged each day dialysis (EDD) Make the most of IHD equipment with minor modifications

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SLED Decrease value Simplicity Comfort Earlier makes an attempt – 1980’s
Widespread type of RRT in ICU in Adults P. Palvesky C JASN 2007, 2: 623 Ricci & Ronco NDT – Kudoh & Kilhara Jpn Cir J 1988 Nephron 1999

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SLED vs CRRT vs IHD

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SLED Technical concerns
Versatile choices QD permitting low flows hybrid remedies Devoted hybrid remedy display screen Commonplace process for altering between HD & hybrid remedy

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SLED Fresenius 2008 – H (US) Hybrid – F 2008 Okay USA Gambro Artis
Fresenius Genius NX stage system one 5008-H

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SLED Dialysate composition
Bicarbonate proportioning system single go Length > 8 hrs Okay – 4.0 meq/L, HCO meq/L, Ca meq/L Length < 8 hrs Okay – 3.0 meq/L, HCo meq/L, Ca meq/L

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SLED Prescription Circuit QB Anticoagulation
Commonplace extracorporeal tubing & dialyzers QB maximized to tolerance of the affected person & extra-corporeal circuit clotting Anticoagulation decrease QB used  clotting Heparin; Citrate dialysate Frequent saline flush Tu & Ahmad. Dial Trans. 2000,29:620 Madison et al . JASN 2005

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SLED Ultrafiltration price
Objectives Medical want & tolerance Cardiovascular stability

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SLED Electrolyte & Dietary Issues
Alkalosis Hypophosphatemia – Phosphate complement No albumin losses amino acid losses of gms in adults Kidney Int. 2001;60(2):777. Intensive Care Med. 1997;23(1):110.

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SLED Drug clearance Appreciable – in between IHD & CRRT
Used for drug toxicity Kielstein et al Crit. Care Med 2006; 34-51 Lund B et al NDT 2005; 20:1483 NDT Plus (2008) 1 (5):

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Drug Pharmacokinetics
Elimination Excessive water solubility Low molecular weight (<500 dalton) Small Vd (<1 l ⁄ kg) Minimal protein binding Intermittent nature Vancomycin whole reduction-36% (8 hr remedy) Beneath therapeutic window at finish of 8 hrs Elimination most throughout 1st 4 hrs Rebound much less Golestaneh. Clin Nephrol 2009;72: Mushatt DM et al. Clin Infect Dis 2009;49:433–437 Dosage after remedy Therapeutic drug monitoring

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SLED Price 5 – 8 occasions inexpensive than CRRT SLED/SLED-F 100$
CRRT 500$ + ongoing prices Alam et al AJKD 2000 Ma T et al – Nephrology 2000 Berbace KI 2006

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Nursing duties for SLED vs CRRT
Hybrid CRRT HD nurse/Tech. ICU nurse Setup + Initiation Inservice ICU N/R Entry Care Troubleshooting Extracorporeal circuit or hemodialyzer change Routine discontinuation Emergency continuation Clearance Blood attracts Hourly monitoring Anticoagulation monitoring

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Nursing duties for SLED vs CRRT
Hybrid CRRT HD nurse/Tech. ICU nurse Setup + Initiation Inservice ICU N/R Entry Care Troubleshooting Extracorporeal circuit or hemodialyzer change Routine discontinuation Emergency continuation Clearance Blood attracts Hourly monitoring Anticoagulation monitoring

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SLED vs CVVHD: Grownup information
2012 2013 2014

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Worldwide Pediatric Dialysis Survey
Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

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Price of care supplied Not insured Out of pocket bills
Worldwide Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

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Alternative of modality in unstable pediatric sufferers
Worldwide Pediatric Dialysis Modality Survey Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

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Availability of SLED Worldwide Pediatric Dialysis Modality Survey
Bunchman T, USA; Sethi SK, India; Raina R, USA; Askenazi D, USA; Akash Deep, UK

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SLED in Adults: Proof

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Pediatric SLED: Proof?

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Taiwan <20Kg excluded

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p<0.02 p=0.15

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SLED seems to be a sturdy renal substitute remedy for critically ailing sufferers with AKI and combines the therapeutic benefits of CRRT with logistic & value benefits of IHD Want for extra research Dialysis Modality Alternative and Initiation – World preferences. McCulloch, Sethi, Xu. ‘Pediatric Kidney Illness’.


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