***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Acute kidney injury ( AKI ) is associated with a high mortality of up to 60 % . The mode of renal replacement therapy ( intermittent versus continuous ) has no impact on patient survival . Sustained low efficiency dialysis using a single-pass batch dialysis system ( SLED-BD ) has recently been introduced for the treatment of dialysis-dependent AKI . To date , however , only limited evidence is available in the comparison of SLED-BD versus continuous veno-venous hemofiltration ( CVVH ) in intensive care unit ( ICU ) patients with AKI . Methods Prospect i ve , r and omized , interventional , clinical study at a surgical intensive care unit of a university hospital . Between 1 April 2006 and 31 January 2009 , 232 AKI patients who underwent renal replacement therapy ( RRT ) were r and omized in the study . Follow-up was assessed until 30 August 2009 . Patients were either assigned to 12-h SLED-BD or to 24-h predilutional CVVH . Both therapies were performed at a blood flow of 100 to 120 ml/min . Results 115 patients were treated with SLED-BD  ( total number of treatments n = 817 ) and 117 patients with CVVH ( total number of treatments n = 877).The primary outcome measure , 90-day mortality , was similar between groups ( SLED : 49.6 % vs. CVVH : 55.6 % , P = 0.43 ) . Hemodynamic stability did not differ between SLED-BD and CVVH , whereas patients in the SLED-BD group had significantly fewer days of mechanical ventilation ( 17.7 ± 19.4 vs. 20.9 ± 19.8 , P = 0.047 ) and fewer days in the ICU ( 19.6 ± 20.1 vs. 23.7 ± 21.9 , P = 0.04 ) . Patients treated with SLED needed fewer blood transfusions ( 1,375 ± 2,573 ml vs. 1,976 ± 3,316 ml , P = 0.02 ) and had a substantial reduction in nursing time spent for renal replacement therapy ( P < 0.001 ) result ing in lower costs . Conclusions SLED-BD was associated with reduced nursing time and lower costs compared to CVVH at similar outcomes . In the light of limited health care re sources , SLED-BD offers an attractive alternative for the treatment of AKI in ICU patients .Trial registration Clinical Trials.gov We conducted a prospect i ve , r and omized study to compare conventional continuous venovenous hemodiafiltration ( CVVHDF ) with sustained hemodiafiltration ( SHDF ) using an acetate-free dialysate . Fifty critically ill patients with acute kidney injury ( AKI ) who required renal replacement therapy were treated with either CVVHDF or SHDF . CVVDHF was performed using a conventional dialysate with an effluent rate of 25 mL·kg−1 · h−1 , and SHDF was performed using an acetate-free dialysate with a flow rate of 300−500 mL/min . The primary study outcome , 30 d survival rate was 76.0 % in the CVVHDF arm and 88.0 % in the SHDF arm ( NS ) . Both the number of patients who showed renal recovery ( 40.0 % and 68.0 % , CVVHDF and SHDF , resp . ; P < .05 ) , and the hospital stay length ( 42.3 days and 33.7 days , CVVHDF and SHDF , resp . ; P < .05 ) , significantly differed between the two treatments . Although the total convective volumes did not significantly differ , the dialysate flow rate was higher and mean duration of daily treatment was shorter in the SHDF treatment arm . Our results suggest that compared with conventional CVVHDF , more intensive renal support in the form of post-dilution SHDF with acetate-free dialysate may accelerate renal recovery in critically ill patients with AKI BACKGROUND In postsurgical acute renal failure patients with moderate unstable hemodynamics or fluid overload , the choice of dialysis modality is difficult . This study was performed to compare the outcomes between the sustained low-efficiency dialysis ( SLED ) and continuous veno-venous hemofiltration ( CVVH ) in these patients . METHODS Sequential postsurgical acute renal failure patients undergoing acute dialysis with CVVH ( 2002 - 2003 ) , or SLED ( 2004 - 2005 ) as a result of severe fluid overload or moderately unstable hemodynamics were analyzed . Multivariate analyses of comorbidity , disease severity before initiating dialysis , biochemical measurements , and hemodynamic parameters for 3 days after the first dialysis session were performed by fitting multiple logistic regression models to predict patient 's 30-day after hospital discharge ( AHD ) mortality . RESULTS Among the 101 recruited patients , 38 received SLED and the rest received CVVH . The 30-day AHD mortality was 62.4 % . The independent risk factors of 30-day AHD mortality included older age ( P = .008 ) , lower first postdialysis mean arterial pressure ( MAP ) ( P = .021 ) , higher first postdialysis blood urea nitrogen level ( P = .009 ) , and absence of a history of hypertension ( P = .002 ) . A further linear regression analysis found that dialysis using SLED was associated with higher first postdialysis MAP ( P = .003 ) . CONCLUSIONS Among the postsurgical patients requiring acute dialysis with severe fluid overload or moderately unstable hemodynamics , the patients treated with SLED had a higher first postdialysis MAP than those treated with CVVH , which led to lower mortality . Further multicenter r and omized clinical trials of larger sample size are needed to compare the effects of SLED and CVVH on the outcomes of postsurgical acute dialysis patients Hemodialysis ( HD ) for critically ill patients with acute renal failure has been provided as intermittent hemodialysis ( IHD ) or continuous renal replacement therapy ( CRRT ) . IHD is often complicated by hypotension and inadequate fluid removal , and CRRT by high cost of solutions and problems with anticoagulation . Sustained low-efficiency daily dialysis ( SLED ) has been suggested as an alternative treatment . This is an observational , prospect i ve pilot study describing the introduction of SLED at our institution . We compared  SLED ( 23 patients , 165 treatments ) with CRRT ( 11 patients , 209 days ) , focusing on cost , anticoagulation , and small solute removal .  SLED consisted of 8 h of HD 6 days a week , with blood flow of 200 ml/min , dialysate flows of 350 ml/min , and hemofiltration with 1 l of saline/h .  CRRT  patients were anticoagulated with either heparin or citrate , and SLED patients with either heparin or saline flushes . The weekly costs to the hospital were $ 1431 for SLED , $ 2607 for CRRT with heparin , and $ 3089 for CRRT with citrate . Sixty-five percent of SLED treatments were heparin-free ; filter clotting occurred in 18 % of heparin treatments and 29 % of heparin-free treatments ( NS ) . Weekly Kt/V was significantly higher for SLED ( 8.4+/-1.8 ) and time-averaged serum creatinine was lower ; equivalent renal clearance ( EKRjc ) was 29+/-6 ml/min for SLED , similar to that for CRRT . In summary , SLED may be routinely performed without anticoagulation ; it provides solute removal equivalent to CRRT at significantly lower cost OBJECTIVE To assess the causes , the prognostic factors , and the outcome of patients with severe acute renal failure . DESIGN Prospect i ve , multicenter study . SETTING Twenty French multidisciplinary intensive care units ( ICUs ) . PATIENTS All patients with severe acute renal failure were prospect ively enrolled in the study for a 6-month period . Severe acute renal failure was defined by the following criteria : a ) a serum creatinine concentration of > or = 3.5 mg/dL ( > or = 310 mumol/L ) and /or a blood urea nitrogen concentration of > or = 100 mg/dL ( > or = 36 mmol/L ) ; or b ) an increase in blood urea nitrogen or serum creatinine concentration , such that the concentration is 100 % above the baseline value in patients with previous chronic renal insufficiency ( serum creatinine concentration of > 1.8 mg/dL [ > 150 mumol/L ] ) , excluding those patients with a basal serum creatinine concentration of > 3.4 mg/dL ( > 300 mumol/L ) . INTERVENTIONS None . MEASUREMENTS AND MAIN RESULTS Age , sex , previous health status and preexisting organ dysfunction , and type and origin of acute renal failure were recorded . The Simplified Acute Physiology Score , the Acute Physiology and Chronic Health Evaluation ( APACHE II ) score , and the number of Organ System Failures were calculated on ICU day 1 and at the time of inclusion in the study . Prognostic factors were determined by univariate methods and stepwise logistic regression analysis . There were 360 patients in the study ; 217 patients were admitted to the study at the time of ICU admission and 143 patients were admitted to the study after ICU admission . Only 41 % of these patients were in good health 3 months before ICU entry . The reason for admission was medical in 78 % of cases . The type of acute renal failure was prerenal ( n = 16 ) , renal ( n = 282 ) , or postrenal ( n = 17 ) .  Renal replacement therapy was used in 174 patients . Two hundred ten ( 58 % ) patients died during the hospital stay . Using stepwide logistic regression , seven variables were predictive of death . These variables were advanced age , altered previous health status , hospitalization before ICU admission , delayed occurrence of acute renal failure , sepsis , oliguria , and severity of illness as assessed at the time of study inclusion by Simplified Acute Physiology Score , APACHE II , or Organ System Failure . CONCLUSIONS The hospital mortality rate of patients with severe acute renal failure in patients requiring intensive care remains high . In order to compare patient groups in further trials concerning acute renal failure , recorded characteristics of the population should include age , previous health status , disease characteristics ( initial or delayed acute renal failure , oliguria , sepsis ) , and the severity of the illness as assessed by physiologic scoring systems recorded at the time of study inclusion Objective : 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 ) . Subjects and Methods : Medical records of patients with AKI/DN from January 2006 to December 2012 were review ed . 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 . Results : 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 . Conclusions : 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 , r and omized sample sizes are needed to confirm these findings 
    Output:
    
There appears to be no clear for advantage continuous renal replacement in the hemodynamically unstable patient .
Currently , both modalities are safe and effective means of treating AKI in the critically ill adult