Sustained Low-Efficiency Daily Dialysis (SLEDD) is a hybrid dialysis modality combining features of both intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). It is designed specifically for critically ill patients who require gentle fluid and solute removal without the hemodynamic instability associated with conventional hemodialysis. SLEDD is performed over an extended period—typically 6 to 12 hours—using lower blood and dialysate flow rates compared to standard HD. This slow and steady process ensures safer fluid removal, making it ideal for patients in intensive care units (ICUs).
SLEDD offers several clinical advantages. It provides effective clearance of uremic toxins, correction of acidosis, and management of electrolyte imbalance while maintaining cardiovascular stability. Unlike CRRT, it does not require 24-hour continuous operation, making it logistically easier for healthcare teams. It also uses standard dialysis machines with minimal additional equipment, reducing overall cost. This makes SLEDD a practical choice in hospitals where CRRT may not be readily available.
Another benefit of SLEDD is its flexibility. Treatments can be scheduled daily or on alternate days depending on the patient’s clinical condition. The slower ultrafiltration rate reduces the risk of hypotension, thereby supporting patients with sepsis, cardiac dysfunction, or multi-organ failure. SLEDD is also useful in managing fluid overload, a common problem in critically ill patients receiving large volumes of intravenous fluids.
However, SLEDD is not without limitations. Although gentler than standard HD, it still requires nursing supervision and continuous monitoring during the session. Patients with severe hemodynamic instability may still require CRRT. Additionally, because SLEDD is not continuous, metabolic fluctuations may occur between sessions.
Overall, SLEDD is a versatile, cost-effective, and clinically safe dialysis method that bridges the gap between intermittent and continuous therapies. It has become an important modality in ICUs worldwide for managing acute kidney injury in critically ill patients.
