Consideration of a newborn with severe acute kidney failure treated successfully with sustained low efficiency dialysis (SLED)

Abstract

A 14-day-old newborn with acute kidney injury associated with systemic herpes simplex virus infection was treated successfully with sustained low efficiency dialysis (SLED). The patient had developed multiple organ failure including kidney failure, liver failure, and bleeding disorders. To perform neonatal SLED, we used a common continuous renal replacement therapy machine designed for adult treatment (KM-8900; Kawasumi Laboratories, Inc., Japan); a hemofilter designed for pediatric use(EXCELFLO AEF03; Asahikasei Medical Co., Ltd., Japan); and a pediatric blood circuit with a priming volume of 70mL. For the vascular access needed for dialysis, indwelling needles were inserted into arterial (24-gauge) and venous vessels (22-gauge). The blood flow rate was 15～20mL/min, and the dialysate flow rate was 250mL/h. The treatment time was up to 11 h. At the start of dialysis, the blood circuit was filled with red cell concentrate and fresh frozen plasma. Continuous renal replacement therapy is generally the main modality for children; however, we selected SLED to avoid continuous use of anticoagulates and to save time for other therapeutic procedures. Six sessions of SLED were completed successfully without affecting the patient’s vital signs. The patient’s condition improved, including kidney failure recovery, and the patient was discharged on day 66 of the hospital stay. In conclusion, SLED can be performed safely in newborns and has several advantages, such as reducing the risk of bleeding and saving time for other procedures.