Determination of Adequacy of Hemodialysis (SLED vs. IHD) Delivered Among Critically Ill Patients in Medical ICU

INTRODUCTION: Renal failure is prevalent among ICU patients, necessitating renal replacement therapy(1). This study evaluates the adequacy of hemodialysis among critically ill ICU patients by comparing sustained low-efficiency dialysis (SLED) and intermittent hemodialysis (IHD). OBJECTIVES: To determine the adequacy of SLED versus IHD in terms of the urea reduction ratio (URR) among critically ill patients in ICU setting. MATERIALS AND METHODS: A prospective observational study was conducted on 84 patients in the multidisciplinary ICU at IQRAA International Hospital, Calicut, from September 2022 to December 2023. Patients, monitored over 28 and 90 days, were assessed for URR as an indicator of dialysis adequacy. Hemodynamic stability and patient outcomes were also evaluated. RESULTS: The mean URR achieved was 51% for both SLED and IHD, below the ideal 65% target due to patient instability and frequent treatment interruptions. At follow-up, no significant differences were found between SLED and IHD in terms of URR or renal recovery. SLED was associated with increased hemodynamic instability, especially in critically unstable patients. DISCUSSIONS/CONCLUSIONS: The study concludes that both SLED and IHD provide comparable dialysis adequacy in critically ill patients, though prolonged or frequent sessions may be required given the high catabolic states and complex conditions of ICU patients. These findings highlight the need for personalized dialysis strategies tailored to patient stability, condition severity, and response to treatment in ICU settings.(2)