Elimination Rates of Electrolytes, Vitamins, and Trace Elements during Continuous Renal Replacement Therapy with Citrate Continuous Veno-Venous Hemodialysis: Influence of Filter Lifetime

Abstract

Background/Aims: During continuous renal replacement therapy, relevant losses of nutritional substrates, vitamins, and trace elements via the filter may occur. We investigated filter lifetime efficiency during a 72-h treatment period. Methods: This prospective study included 40 patients undergoing citrate continuous veno-venous hemodialysis (CVVHD). The elimination rates were measured at 24, 48, and 72 h. To assess the influence of filter lifetime, we determined substrate loss every 24 h over a 72-h interval. Results: Filter lifetime did not affect the loss of ionized calcium, inorganic phosphate, magnesium, zinc, folic acid, and vitamin B12. Nevertheless, we did observe clinically significant loss of ionized calcium and inorganic phosphate during CVVHD that required supplementation. Conclusions: CVVHD leads to significant loss of ionized calcium and inorganic phosphate that is independent of the filter lifetime.

Nutrients and micronutrients at risk during renal replacement therapy: a scoping review

“…The same group reported the depletion effect of CRRT on Cu and Se during a case of prolonged CRRT confirming, resulting in life-threatening complications [ 13 ]. In their first study, Datzmann et al [ 14 ] detected zinc, but no copper, but could not find significant Zn losses in their second study [ 15 ]. Pasko et al detected Cu, Se, Mn Se and Zn in effluent of children undergoing RRT (Table 1 ).…”

“…The most recent showed losses of vitamin C [ 9 ▪▪ , 19 ▪▪ ] but B1, B6, B12, D2, D3 could not be detected [ 19 ▪▪ ]. Searching for vitamins A, B9, B12 and E, Datzmann et al could not detect any in effluent fluid [ 14 , 15 ]. Similarly, Story et al found that vitamin C was detectable in the effluent, but vitamin E was not (Table 1 ).…”

“…In a critical care setting levels of vitamin A and E seem to be lowered, and activation of vitamin D 3 is impaired in patients with AKI [ 22 – 24 ]. Two studies reported that they did not find vitamin A or E in effluent fluid [ 14 ], and a third study did not find vitamin D [ 19 ▪▪ ]. In general, vitamin A, D and E are not prone to be removed by convective and diffusion-based processes, in contrast to water soluble molecules.…”

“…Expert opinion and the data retrieved in this scoping review suggest that water-soluble vitamins should be administered routinely during CRRT, but controversy exists about the optimal dosage, timing, and duration [ 45 – 47 ]. Recommendations from experts [ 10 – 14 , 17 ], official societies [ 48 ] and authorities vary [ 22 , 46 , 49 ▪▪ , 50 , 51 ]. A recent review on nutrition therapy during CRRT in critically ill children proves a dearth of information and shares weak recommendations [ 52 ].…”

Nutrition Support During Pediatric Extracorporeal Membrane Oxygenation

“…The mechanisms of these alterations in micronutrients are not clear, but their impact on outcomes in pediatric ECMO may be important and require further investigation. In patients receiving ECMO who also require dialysis, micronutrient losses may be further compounded, because continuous renal replacement therapy has been associated with loss of ionized calcium, inorganic phosphorus, and selenium, among other trace elements . These observations may have implications for micronutrient supplementation in the pediatric ECMO population, and attempts to monitor micronutrients should be made.…”