When is SLEDD preferred over CRRT for ICU AKI?

SLEDD advantages over CRRT: equivalent solute clearance over 24h, lower cost (30 to 50% less), standard IHD equipment, allows patient mobilization and procedures during off-time, similar hemodynamic tolerance. Preferred when: hemodynamic instability precludes IHD but patient leaves ICU for procedures, or resource limitations exist. Outcomes equivalent to CRRT in RCT data.

How is anticoagulation managed during SLEDD?

UFH most common: bolus 1000 to 2000 U at circuit start + 500 to 1000 U/h infusion. Target systemic aPTT 45 to 60 seconds. Regional citrate can be adapted for SLEDD machines. For HIT: argatroban or bivalirudin at reduced doses (cleared by dialysis). For high bleeding risk: saline flushes every 30 to 60 min without anticoagulation (shorter circuit life).

SLEDD Session Planning Calculator

Plan sustained low-efficiency daily dialysis (SLEDD) sessions: 6 to 12 hour sessions at 200 to 300 mL/min blood flow and 150 to 250 mL/min dialysate flow as a hybrid approach between IHD and CRRT for hemodynamically unstable AKI.

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Frequently Asked Questions

When is SLEDD preferred over CRRT for ICU AKI?

How is anticoagulation managed during SLEDD?