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Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults.
Ren Fail. 2019 Nov; 41(1):72-79.RF

Abstract

BACKGROUND

Hypophosphatemia is common during continuous renal replacement therapy (CRRT) in critically ill patients and can cause generalized muscle weakness, prolonged respiratory failure, and myocardial dysfunction. This study aimed to investigate the efficacy and safety of adding phosphate to the dialysate and replacement solutions to treat hypophosphatemia occurring in intensive CRRT in critically ill patients.

METHODS

We retrospectively analyzed 73 patients treated with intensive CRRT (effluent flow ≥35 ml/kg/hr) in the intensive care unit. The control group (group 1, n = 22) received no phosphate supplementation. The treatment groups received dialysate and replacement solution phosphate supplementation at 2.0 mmol/L (group 2, n = 26) or 3.0 mmol/L (group 3, n = 25).

RESULTS

The CRRT-induced hypophosphatemia incidence was 59.0%. Correction of hypophosphatemia with phosphate supplementation changed the mean serum phosphorus levels to 1.24 ± 0.37 and 1.44 ± 0.31 mmol/L in groups 2 and 3, respectively (p = .02). The time required for correction was 1.65 ± 0.80 and 1.39 ± 1.43 days for groups 2 and 3, respectively and was significantly longer in group 2 (p = .02). After supplementation, hypophosphatemia, and hyperphosphatemia both occurred in 7% of group 2. Group 3 developed no hypophosphatemia, but 20% developed hyperphosphatemia. The serum phosphate levels in hyperphosphatemia cases returned to normal within 2.0 days (group 2) and 1.0 day (group 3) after stopping phosphate supplementation.

CONCLUSION

Phosphate supplementation effectively corrected CRRT-induced hypophosphatemia in critically ill patients with an acute kidney injury. The use of 2 mmol/L phosphate is appropriate in patients with CRRT-induced hypophosphatemia, but a different concentration could be required to prevent hypophosphatemia at the start of CRRT.

Authors+Show Affiliations

a Dialysis Center , Konkuk University Medical Center , Seoul , Korea.b Department of Cellular and Molecular Medicine , Konkuk University School of Medicine , Seoul , Korea.c College of Nursing , The Catholic University of Korea , Seoul , Korea.a Dialysis Center , Konkuk University Medical Center , Seoul , Korea. d Division of Nephrology , Konkuk University School of Medicine , Seoul , Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30909778

Citation

Song, Young-Hye, et al. "Phosphate Supplementation for Hypophosphatemia During Continuous Renal Replacement Therapy in Adults." Renal Failure, vol. 41, no. 1, 2019, pp. 72-79.
Song YH, Seo EH, Yoo YS, et al. Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults. Ren Fail. 2019;41(1):72-79.
Song, Y. H., Seo, E. H., Yoo, Y. S., & Jo, Y. I. (2019). Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults. Renal Failure, 41(1), 72-79. https://doi.org/10.1080/0886022X.2018.1561374
Song YH, et al. Phosphate Supplementation for Hypophosphatemia During Continuous Renal Replacement Therapy in Adults. Ren Fail. 2019;41(1):72-79. PubMed PMID: 30909778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phosphate supplementation for hypophosphatemia during continuous renal replacement therapy in adults. AU - Song,Young-Hye, AU - Seo,Eun-Hye, AU - Yoo,Yang-Sook, AU - Jo,Young-Il, PY - 2019/3/27/entrez PY - 2019/3/27/pubmed PY - 2019/4/17/medline KW - Hypophosphatemia KW - continuous renal replacement therapy KW - hyperphosphatemia KW - phosphate KW - supplementation SP - 72 EP - 79 JF - Renal failure JO - Ren Fail VL - 41 IS - 1 N2 - BACKGROUND: Hypophosphatemia is common during continuous renal replacement therapy (CRRT) in critically ill patients and can cause generalized muscle weakness, prolonged respiratory failure, and myocardial dysfunction. This study aimed to investigate the efficacy and safety of adding phosphate to the dialysate and replacement solutions to treat hypophosphatemia occurring in intensive CRRT in critically ill patients. METHODS: We retrospectively analyzed 73 patients treated with intensive CRRT (effluent flow ≥35 ml/kg/hr) in the intensive care unit. The control group (group 1, n = 22) received no phosphate supplementation. The treatment groups received dialysate and replacement solution phosphate supplementation at 2.0 mmol/L (group 2, n = 26) or 3.0 mmol/L (group 3, n = 25). RESULTS: The CRRT-induced hypophosphatemia incidence was 59.0%. Correction of hypophosphatemia with phosphate supplementation changed the mean serum phosphorus levels to 1.24 ± 0.37 and 1.44 ± 0.31 mmol/L in groups 2 and 3, respectively (p = .02). The time required for correction was 1.65 ± 0.80 and 1.39 ± 1.43 days for groups 2 and 3, respectively and was significantly longer in group 2 (p = .02). After supplementation, hypophosphatemia, and hyperphosphatemia both occurred in 7% of group 2. Group 3 developed no hypophosphatemia, but 20% developed hyperphosphatemia. The serum phosphate levels in hyperphosphatemia cases returned to normal within 2.0 days (group 2) and 1.0 day (group 3) after stopping phosphate supplementation. CONCLUSION: Phosphate supplementation effectively corrected CRRT-induced hypophosphatemia in critically ill patients with an acute kidney injury. The use of 2 mmol/L phosphate is appropriate in patients with CRRT-induced hypophosphatemia, but a different concentration could be required to prevent hypophosphatemia at the start of CRRT. SN - 1525-6049 UR - https://www.unboundmedicine.com/medline/citation/30909778/Phosphate_supplementation_for_hypophosphatemia_during_continuous_renal_replacement_therapy_in_adults_ L2 - https://www.tandfonline.com/doi/full/10.1080/0886022X.2018.1561374 DB - PRIME DP - Unbound Medicine ER -