• Abdulla K Salahudeen, Vikas Kumar, Niti Madan, Lianchun Xiao, Amit Lahoti, Joshua Samuels, Joseph Nates, and Kristen Price.
• Nephrology Section, Department of General Internal Medicine AT&EC, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. aksalahudeen@mdanderson.org
• Clin J Am Soc Nephrol. 2009 Aug 1; 4 (8): 1338-46.

Background And ObjectivesOliguric, hypotensive patients who require large amounts of fluids may benefit from sustained low-efficiency dialysis performed continuously (C-SLED). C-SLED through higher clearance may improve survival, or through greater nutritional loss may worsen survival. No studies have assessed survival on C-SLED. The objective was to examine patient outcomes and survival predictors on C-SLED.Design, Setting, Participants, & MeasurementsThe data of 199 consecutive cancer patients treated with C-SLED were analyzed. The median duration of C-SLED was 50 h. With 48 h of C-SLED, the blood urea nitrogen (BUN) and serum creatinine levels had decreased by 80% and 73%, respectively. The mean arterial pressure (MAP) was maintained despite higher ultrafiltration and reduced vasopressor use. The 30-d mortality rate was 65%. Despite excellent dialysis, the sequential organ failure assessment (SOFA) score remained predictive of mortality. In the univariate model, higher SOFA scores and lower values for MAP, blood pH, and serum albumin and creatinine levels were associated with higher mortality. Administration of total parenteral nutrition (TPN) was, however, associated with lower mortality.ResultsIn the multivariate model, the higher SOFA score and lower blood pH, MAP and C-SLED duration were associated with higher mortality. In a subset analysis of 129 patients who received C-SLED for at least 48 h, those with higher BUN levels, which were associated with higher TPN infusion, had a lower mortality risk.ConclusionThis first detailed report on C-SLED indicates that C-SLED can be effective and suggests a link between nutrition and survival.

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