The use of sustained low-efficiency dialysis in the treatment of sepsis associated acute kidney injury in a low-income country: A prospective cohort study

Background: Limited data are available regarding the management and outcomes of patients with sepsis-associated acute kidney injury (SA
AKI) requiring dialysis in Sudan. Continuous renal replacement therapy (CRRT) is a highly favored treatment modality in such patients. However,
it stays unavailable and expensive treatment in most low-income countries. We aimed to evaluate the use of sustained low-efficiency dialysis
(SLED) in the treatment of hemodynamically unstable patients with SA-AKI admitted to the intensive care unit (ICU).
Materials and methods: A prospective cohort was conducted in Baraha Medical City, Khartoum, Sudan. Patients above 18 years of age, who
were admitted to the ICU between January and September 2020 with SA-AKI, and required SLED or CRRT were enrolled. These were followed
up till death or discharge from the ICU. They were observed regarding their dialysis tolerance, rate of renal recovery, ICU mortality, and cost of
therapy. Data analysis was done using SPSS.
Results: Fifty-three adults were enrolled. Their mean age was 62 ± 11 years, and 56.6% were males. Thirty-one patients (58.5%) received SLED
and 22 (41.5%) underwent CRRT. Patients in the two groups were age and sex matched and showed no significant differences in their comorbid
conditions, source of sepsis, sequential organ failure assessment (SOFA) score, and their indications for dialysis (p > 0.05). Patients treated with
SLED showed similar dialysis tolerance, rate of renal recovery, length of ICU admission, and risk of death compared to those treated with CRRT
(p > 0.05). Moreover, SLED treatments were less expensive than CRRT, and the costs of ICU admission among the SLED group were significantly
less (p < 0.001).
Conclusion: Our study shows that SLED is safe and effective. It is readily available and can be routinely performed in the treatment of
hemodynamically unstable patients with SA-AKI at a significantly lower cost.