Sustained low-efficiency dialysis is a hybrid form of
kidney replacement therapy that has gained increasing popularity as an alternative to continuous forms of
kidney replacement therapy in intensive care unit settings. During the
COVID-19 pandemic, the shortage of continuous
kidney replacement therapy equipment led to increasing usage of
sustained low-efficiency dialysis as an alternative treatment for
acute kidney injury.
Sustained low-efficiency dialysis is an efficient method for treating hemodynamically unstable patients and is quite widely available, making it especially useful in resource-limited settings. In this review, we aim to discuss the various attributes of
sustained low-efficiency dialysis and how it is comparable to continuous
kidney replacement therapy in efficacy, in terms of solute kinetics and
urea clearance, and the various formulae used to compare intermittent and continuous forms of
kidney replacement therapy, along with hemodynamic stability. During the
COVID-19 pandemic, there was increased clotting of continuous
kidney replacement therapy circuits, which led to increased use of sustained low-efficiency dialysis alone or together with extra corporeal membrane oxygenation circuits. Although
sustained low-efficiency dialysis can be delivered with continuous
kidney replacement therapy machines, most centers use standard
hemodialysis machines or batch dialysis systems. Even though
antibiotic dosing differs between continuous
kidney replacement therapy and
sustained low-efficiency dialysis, reports of patient survival and renal recovery are similar for continuous
kidney replacement therapy and
sustained low-efficiency dialysis. Health care studies indicate that
sustained low-efficiency dialysis has emerged as a cost-effective alternative to continuous
kidney replacement therapy. Although there is considerable data to support
sustained low-efficiency dialysis treatments for
critically ill adult patients with
acute kidney injury, there are fewer pediatric data, even so, currently available studies support the use of
sustained low-efficiency dialysis for pediatric patients, particularly in resource-limited settings.