**4. Sustained low-efficiency dialysis (SLED) in patients with CHF**

Sustained low-efficiency dialysis (SLED), or sustained low-efficiency daily dialysis (SLEDD), is a conventional hemodialysis that is performed over a longer period (6–12 h) of time using lower rates of blood flow (50–200 mL/min) and dialysate flow (200–400 mL/min). It is an alternative treatment in critically ill patients with affected kidney function [44–46], where fluid is removed slowly over longer time ensuring better hemodynamic stability [47]. This is in particular the case when the cost of HF/HDF is considered expensive. It combines the logistic advantages, the cost-effectiveness and the scheduling flexibility of the intermittent dialysis, and the hemodynamic stability of continuous renal replacement therapy with fewer side effects during the fluid removal [48]. There is still a limited clinical data in the literature on the effectiveness of SLED in patients with CHF. However, Iorio et al.'s experience suggested that SLED is an alternative treatment for acute dialysis in patients with diuretic resistant systolic CHF [49]. Violi et al. mentioned that the SLED as an alternative treatment is the most indicated in NYHA class IV CHF [50].
