Guideline Summary for SLED and SLED‑F Therapy

Dose Targets

Standard SLED should achieve a delivered single‑pool Kt/V ≥ 1.2 per treatment session, using the same Kt/V targets applied to maintenance hemodialysis. This recommendation is based on evidence from the American Journal of Kidney Diseases (2013). 1

Standard SLED is more cost‑effective than convective modalities and is preferred when facilities lack the resources to manage replacement‑fluid logistics. Evidence from two 2013 American Journal of Kidney Diseases studies supports this recommendation. [1][2]

SLED‑F leads to greater loss of amino acids and proteins, comparable to continuous venovenous hemofiltration patterns; therefore, protein intake should be increased to approximately 1.5–1.7 g/kg/day to maintain nitrogen balance. (Clinical Nutrition, 2021). 3
Standard SLED contributes minimal calories (~100–300 kcal/day) when citrate anticoagulation is used with glucose‑containing dialysate, limiting the need for additional caloric supplementation. (Clinical Nutrition, 2021). 3

When enhanced middle‑molecule clearance is clinically important—such as in sepsis with accumulation of inflammatory mediators or tumor‑lysis syndrome—SLED‑F is the preferred modality because the convective component improves removal of larger solutes. (Haematologica, 2008). 4

Inadequate protein supplementation in patients receiving SLED‑F can result in negative nitrogen balance and malnutrition; proactive adjustment of protein intake to the higher recommended range is essential. (Clinical Nutrition, 2021). 3

SLED is considered a "hybrid" or Prolonged Intermittent Kidney Replacement Therapy (PIKRT), combining features of both intermittent and continuous modalities, with CVVHF running continuously 24 hours per day 5, 6, 7
CVVHF is a pure convective therapy using hemofiltration with replacement fluid administration, with an effluent rate typically prescribed at 20-35 mL/kg/hour 8, 9

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines indicate no clear advantage for CRRT over PIKRT (including SLED) in hemodynamically unstable patients, with a recommendation for individualized treatment choices 7, 10

CVVHF provides continuous therapy with slower, more gradual shifts, and is more efficient for middle and large molecular weight solutes, but requires higher protein intake (1.5-1.7 g/kg/day) due to continuous amino acid and protein losses 7, 8, 11
The American Journal of Kidney Diseases recommends a target dose of at least 20-25 mL/kg/hour effluent for CRRT, with frequent assessment of actual delivered therapy 9, 8

The Clinical Nutrition guidelines state that nutritional considerations differ between SLED and CVVHF, with patients on CVVHF requiring higher protein intake (1.5-1.7 g/kg/day) compared to those on SLED (1.3-1.5 g/kg/day) 11
Praxis Medical Insights recommends regional citrate anticoagulation as first-line for CRRT when no contraindications exist, while SLED may use intermittent heparin dosing similar to conventional hemodialysis 8, 9