Sustained low-efficiency dialysis—an old method but possibly a new solution for environmental nephrology

Slow low-efficiency dialysis (SLED) is viewed historically a 'hybrid' technique of kidney replacement therapy, representing a transition between intermittent and continuous kidney replacement therapy. It can be performed with a mobile single-pass batch dialysis system or multifunctional hemodialysis machines, using reduced dialysate flow and an extended procedure duration. We summarized the technical aspects, as well as the practical advantages of SLED. Moreover, we present our experience of using SLED in selected difficult clinical conditions, such as intraoperative renal replacement therapy during liver transplantation, in sepsis, and in heart failure patients with recalcitrant volume overload. In this paper, we aimed to describe the unique advantages of SLED in terms of efficacy, safety, and, more importantly, sustainability in kidney care in the intensive care units.