Scoping Review of Drug Dosing in Sustained Low Efficiency Dialysis

Purpose: Acute kidney injury (AKI) is a common occurrence in critically ill patients affecting almost 50% of those admitted to an intensive care unit. (Rachoin JS, et al. CCM. 2019) There remains to be a cure for AKI, but renal replacement therapies (RRT) are being used at an increasing rate to manage these patients during their critical illness. (Rachoin JS, et al. CCM. 2019) Various modalities for RRT exist from intermittent hemodialysis (iHD) to continuous renal replacement therapy (CRRT). Sustained low efficiency dialysis (SLED) is an intermediate or hybrid RRT modality combining aspects of both iHD and CRRT. No RRT modality has been shown to be superior to another, however, each modality has its unique risks and benefits. Furthermore, each RRT modality has a particular impact on drug clearance requiring dose modifications specific to the RRT modality selected. Research and dosing recommendations exist for both iHD and CRRT dosing for many medications, however, less attention has been paid to drug dosing in SLED.