CRRT and Phosphate

Q: Which of the following may occur in continuous renal replacement therapy (CRRT)? - select one

A) Hyperphosphatemia

B) Hypophosphatemia 

Answer: B

Hypophosphatemia occurs in CRRT due to the removal of phosphate from effluent waste. It is common in the ICU to do aggressive CRRT via either high dialysate or replacement fluid flow rates. With high demand for CRRT in the ICU, frequent shortages of intravenous phosphate preparations have been reported in the United States. 

Said that Phosphate-containing dialysis solution may help in preventing hypophosphatemia during CRRT.

#nephrology

References:

1. Broman M, Carlsson O, Friberg H, et al. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand 2011; 55:39.

2. Hendrix RJ, Hastings MC, Samarin M, Hudson JQ. Predictors of Hypophosphatemia and Outcomes during Continuous Renal Replacement Therapy. Blood Purif. 2020;49(6):700-707. doi: 10.1159/000507421. Epub 2020 Apr 22. PMID: 32320987.

3. Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Kim I, Lee J, Lo S, McArthur C, McGuinness S, Norton R, Myburgh J, Scheinkestel C. The relationship between hypophosphataemia and outcomes during low-intensity and high-intensity continuous renal replacement therapy. Crit Care Resusc. 2014 Mar;16(1):34-41. Erratum in: Crit Care Resusc. 2014 Jun;16(2):139. McGuiness, Shay [corrected to McGuinness, Shay]. PMID: 24588434.