Electrolytes-Enriched Hemodiafiltration Solutions for Continuous Renal Replacement Therapy in Acute Kidney Injury: A Crossover Study

Abstract

Aims: To evaluate the capability of an electrolytes-enriched solution to prevent metabolic disorders during continuous veno-venous hemodiafiltration (CVVHDF). Methods: Serum biochemistry and clinical tolerance were compared during CVVHDF treatments with an electrolyte-enriched (Phoxilium) or standard solutions in 10 acute renal failure patients. Results: As compared to standard fluids, serum potassium and phosphate levels were maintained in the normal range with Phoxilium without any supplementation but total serum calcium levels were significantly lower. Bicarbonatemia was slightly higher (24-26 vs. 21.5-24.5 mmol/l, p < 0.05) with conventional solutions and was associated with a significant increased level of pH (>7.44). Despite the absence of glucose in the Phoxilium solution, blood glucose levels and glucose supplementation were similar between treatments. Clinical tolerance and efficiency of CVVHDF sessions were comparable. Conclusion: Phoxilium effectively prevented hypophosphatemia and hypokalemia during CVVHDF. It was, however, associated with a slight metabolic acidosis and hypocalcemia compared with conventional solutions.

Impact of electrolyte-rich dialysate during continuous renal replacement therapy on serum phosphate and potassium in ICU patients

“…Hypokalemia can also develop during CRRT, although its incidence is lower than that of hypophosphatemia. Several recent studies have investigated the usefulness of phosphate-and potassium-containing dialysis solution [16,17,20,21]. Broman et al reported that phosphate-containing replacement and dialysis solutions reduced variability in serum phosphate levels during CRRT and the incidence of hypophosphatemia [17].…”

“…Broman et al reported that phosphate-containing replacement and dialysis solutions reduced variability in serum phosphate levels during CRRT and the incidence of hypophosphatemia [17]. In a crossover study, Noemie et al reported that phosphate-and potassium-containing solution prevented hypophosphatemia and hypokalemia during CVVHDF [20].…”

The Japanese clinical practice guideline for acute kidney injury 2016

“…During CRRT, commercially available dialysates and replacement fluids in Japan can cause hypokalemia and hypophosphatemia, and the latter is reported to delay weaning from mechanical ventilation; therefore, appropriate supplementation of potassium and/or phosphate through intravenous or enteral nutrition can be beneficial [ 196 , 211 – 213 ]. Outside of Japan, a CRRT dialysate containing 4.0 mEq/L potassium and 3.7 mg/dl phosphorus has been developed [ 214 ]. However, a switch from CRRT to intermittent renal replacement therapy (IRRT) can easily cause an electrolyte imbalance, thereby calling for a reexamination of the content of the intravenous nutrition or enteral nutrition, including the total fluid volume; in particular, the risk of hyperkalemia must be kept in mind.…”

The Japanese Clinical Practice Guideline for acute kidney injury 2016

“…During CRRT, commercially available dialysates and replacement fluids in Japan can cause hypokalemia and hypophosphatemia, and the latter is reported to delay weaning from mechanical ventilation; therefore, appropriate supplementation of potassium and/or phosphate through intravenous or enteral nutrition can be beneficial [ 194 , 209 – 211 ]. Outside of Japan, a CRRT dialysate containing 4.0 mEq/L potassium and 3.7 mg/dL phosphorus has been developed [ 212 ]. However, a switch from CRRT to intermittent renal replacement therapy (IRRT) can easily cause an electrolyte imbalance, thereby calling for a reexamination of the content of the intravenous nutrition or enteral nutrition, including the total fluid volume; in particular, the risk of hyperkalemia must be kept in mind.…”