Sustained low efficiency dialysis as standard renal replacement therapy in an interdisciplinary intensive care unit-Afive year cost-benefit analysis
Background: Sustained low efficiency dialysis (SLED) as primary renal replacement therapy (RRT) in acute kidney injury (AKI) is not widely used, despite substantial economical advantages. We evaluated costs and outcome ina5year retrospective study on our ICU. Methods:From 2006 to 2010 we selected all patients with the ICD-10 codes N17 and N18 who were treated with SLED on our ICU. Patients with a stay <2 days, an extra-renal indication for dialysis or chronic dialysis were excluded. Variables: number of SLEDs, duration of ICU and hospital stay, ICU and hospital mortality, SAPS II, TISS 28, blood urea and creatinine, C-reactive protein, mechanical ventilation, diagnoses. Long-term outcome was evaluated by sending all discharged patients a questionnaire.
Results: Between 2006 and 2010, 3247 SLED-treatments in 421 patients (mean SAPS II: 41 points without GCS) were performed. ICU and hospital mortality in the patients treated only with SLED (n = 392) was 34% and 45%, respectively. 71% of all surviving patients had good quality of life and 12% of all discharged patients still needed dialysis. Total costs for SLED were 526.819D and total proceeds were 734.996D .Assuming also 3247 "CVVHDF-days" for cost comparisons we calculated costs of 722.750D with proceeds of690.864D for CVVHDF.
Conclusions: In critically ill patients with AKI SLED is an effective RRT, with short- and long-term outcome being comparable to outcome data with CVVHDF. Based on our cost-proceeds analysis SLED seems to be the preferable renal replacement therapy.
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