Introduction Acute kidney injury (AKI) frequently necessitates continuous renal replacement therapy, often causing phosphate and magnesium losses. We evaluated whether a phosphate containing, magnesium-enriched dialysate reduces hypophosphatemia and hypomagnesemia compared to phosphate-free dialysate with standard magnesium concentration during citrate-anticoagulated continuous veno-venous hemodialysis (RCA-CVVHD) in ICU patients. Methods Single-center observational study comparing two adult ICU cohorts undergoing RCA-CVVHD from 2011-2014. The 2011-2012 cohort received phosphate-free dialysate with standard magnesium concentration (0.75 mmol/L) and intravenous phosphate and magnesium supplementation. The 2013-2014 cohort received a phosphate-containing (1.25 mmol/L), magnesium-enriched (1.0 mmol/L) dialysate. The primary endpoint was the incidence of hypophosphatemia and severe hypophosphatemia within 72 hours. Secondary outcomes included magnesium and calcium disturbances, delivered dialysis dose, solute control, filter lifespan, and clinical outcomes. Results We analyzed 85 patients in the 2011-2012 and 97 in the 2013-2014 cohort. Hypophosphatemia (92% vs. 68%, p < 0.001) and severe hypophosphatemia (65% vs. 28%, p < 0.001) were less frequent with phosphate-containing dialysate. Phosphate and magnesium levels were higher (p<0.008) with the phosphate-containing, magnesium-enriched solution. Fewer patients required phosphate (23% vs. 81%, p < 0.001) or magnesium (35% vs. 76%, p < 0.001) infusions. Ionized calcium and total calcium remained within target range in both cohorts. The delivered dialysis dose was 31.0±8.1 mL/kg/h in the 2011-2012 and 28.6±6.6 mL/kg/h in the 2013-2014 cohort (p = 0.025). More filters reached the maximum lifespan of 72 hours in the 2013-2014 cohort (64% vs. 75%; p = 0.03). Solute clearance and acid-base control were similar. Conclusion In ICU patients undergoing RCA-CVVHD, a phosphate-containing, magnesium-enriched dialysate was associated with significantly lower incidence and severity of hypophosphatemia, higher phosphate and magnesium levels, and lower need for separate electrolyte infusions. This phosphate-containing solution may offer relevant benefits, including reduced workload and potentially increased patient safety. These findings require confirmation in a RCT that includes relevant clinical endpoints.

Extracorporeal life support (ECLS), most commonly delivered as extracorporeal membrane oxygenation (ECMO), is a lifesaving therapy for refractory cardiac and respiratory failure. Acute kidney injury (AKI) is among the most frequent complications associated with ECMO, occurring in 40-80% of patients, with approximately 40-50% receiving continuous renal replacement therapy (CRRT). AKI in this setting is multifactorial, reflecting pre-ECMO shock or hemodynamic instability, systemic inflammation, hemolysis, venous congestion, non-pulsatile flow, nephrotoxic exposure, and fluid overload. Both AKI and CRRT among patients receiving ECMO are independently associated with increased mortality, prolonged duration of support, and long-term risk of chronic kidney disease (CKD). This review was developed in pursuit of the 36th Acute Disease Quality Initiative (ADQI XXXVI) consensus conference, during which international experts in nephrology, critical care, cardiology, perfusion, and extracorporeal support convened to evaluate current evidence and generate consensus statements regarding the epidemiology, prevention, and management of AKI in patients receiving ECLS. The conference emphasized harmonization of definitions, identification of modifiable risk factors, optimization of CRRT strategies, and prioritization of future research directions. We highlight key epidemiologic patterns, mechanistic drivers, CRRT utilization, short- and long-term outcomes, and research priorities. Particular attention is given to the need for standardized definitions, prospective multicenter trials, biomarker validation, and integration of nephrology expertise into ECMO programs to improve kidney-related outcomes in this high-risk population.

This selection of abstracts from the 44th Vicenza Course AKI-CRRT-EBPT and Critical Care Nephrology is a collection of recent studies on Acute Kidney Injury and Critical Care Nephrology. The manuscripts, from all over the world, present different cases of real-life experiences and might be a great opportunity of consultation for peers and experts looking for discussion and comparison.