Sustained low-efficiency daily diafiltration for diabetic nephropathy patients with acute kidney injury

To investigate the efficacy, safety and cost of treating patients with acute kidney injury [AKI] and diabetic nephropathy [DN] with continuous renal replacement therapy [CRRT] or sustained low-efficiency daily diafiltration with hemofiltration [SLEDD-f]. Medical records of patients with AKI/DN from January 2006 to December 2012 were reviewed. Fifty-five patients who received CRRT and 52 who received SLEDD-f were included in the study. CRRT and SLEDD-f were performed for 20-72 h per session and 8-10 h per session, respectively. Mortality and renal function recovery rates were evaluated 30 days after the initiation of renal replacement therapy [RRT] and APACHE-II and SOFA scores, anticoagulant dose, inflammatory indices and cost were calculated at baseline and at the end of RRT. Of the 55 patients treated with CRRT, 49 [89.1%] had a 30-day survival rate and 30 [54.5%] had a 30-day renal recovery rate. Of the 52 patients with SLEDD-f, these rates were 92.3% [n = 48] and 61.5% [n = 32], respectively. The dosage of low-molecular-weight heparin in the CRRT and SLEDD-f groups was 15,230 +/- 1,460 and 6,320 +/- 490 U/day, respectively. The cost of hemopurification and the total cost for patients treated with CRRT was CNY 28,628 +/- 5,576 [USD 4,210 +/- 820] and CNY 38,828 +/- 6,324 [USD 5,710 +/- 930], respectively. These were higher than those for patients treated with SLEDD-f at CNY 13,260 +/- 1,564 [USD 1,950 +/- 230] and CNY 19,720 +/- 2,652 [USD 2,900 +/- 390], respectively. SLEDD-f offered a similar chance of renal recovery and also had further advantages such as a lower heparin dosage, a shorter therapy time and lower hospitalization costs for patients than CRRT. Studies with larger, randomized sample sizes are needed to confirm these findings