SLEDD Slows Dialysis, Speeds Recovery at The Queen's Medical Center

To the right are James Madison, DO, and Eugene Wong, MD, with the Queen's Hemodialysis team. Because of the nature of its patients and the need to maintain high quality care, Queen's Hemodialysis has required all of its staff to be ICU trained from its inception in 1987.

Despite the speedy implication of its acronym, SLEDD is actually slow. Slow Extended Daily Dialysis, or SLEDD, is a hybrid form of dialysis which brings much needed relief to renal patients who would otherwise need round the clock dialysis, or CRRT (continuous renal replacement therapy). The Queen's Medical Center is the first in Hawaii to pioneer this form of dialysis.

With SLEDD, much less stable patients can now be given dialysis for just six hours a day for six days (with one day off) vs. 24 hours a day everyday. Some patients are even able to reduce dialysis to every other day. This frees patients to benefit from other rehabilitation therapies and to have diagnostic tests. "Patients get a superior dose of dialysis in six hours compared to 24 hours [of CRRT]," says James Madison, DO (Doctor of Osteopathy). The evidence-based technique was pioneered at UC Davis, where Dr. Madison was trained. Along with partner Eugene Wong, MD, medical director of Hemodialysis, he spearheaded the effort to bring SLEDD to Queen's.

SLEDD works by using slower blood pumps while delivering a higher dose of dialysis than CRRT. "By doing it all slower, patients are able to tolerate [dialysis] well," says Dr. Madison. "They are very hemodynamically stable." Because of this, the technique can be applied to many critical care patients across all Intensive Care Unit (ICU) disciplines. "In Hawaii, about 14 percent of ICU patients are on CRRT," he continued. "Conservatively, more than half of those patients will tolerate this procedure safely." Dr. Madison believes that up to 75 percent may benefit.