title: Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy.
abstract: OBJECTIVE
  Hypophosphatemia often occurs during continuous renal replacement therapy (CRRT). The addition of phosphate to dialysate and replacement solutions facilitates phosphate handling, but the risk of precipitation with calcium within these solutions has not been addressed.
  
  
  METHODS
  Experimental study with a retrospective observational study in a medico-surgical intensive care unit.
  
  
  METHODS
  We tested the addition of phosphate to calcium-rich lactate- and bicarbonate-based solutions (Hemosol LG2 and Hemosol B0) used in CRRT to see whether precipitation occurs. Two milliliters of potassium phosphate added to 5-l bags gives a physiological phosphate concentration of 1.2 mmol/l. In addition, calcium and phosphate homeostasis was retrospectively evaluated in 20 consecutive CRRT patients where potassium phosphate had been added to these solutions.
  
  
  RESULTS
  Total and ionized calcium, phosphate, pH, PCO(2) and bicarbonate remained essentially unchanged 5 h after the addition of 2 ml of potassium phosphate to 5-l Hemosol solutions. Visual inspection did not reveal any precipitate. Of the 20 patients studied, 14 received more than 24 h of phosphate supplementation to dialysate and replacement solutions. Phosphate remained stable throughout CRRT despite phosphate intake from nutrition in 11 cases. No adverse event was noted on potassium, calcium, pH and bicarbonate homeostasis.
  
  
  CONCLUSIONS
  The addition of phosphate to Hemosol solutions does not precipitate with the calcium within these solutions. This practical method effectively prevents hypophosphatemia in CRRT patients.
authors.affiliation: Division of Nephrology and Critical Care, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 de l'Assomption, Montreal, Quebec, Canada.
authors.forename: Stéphan
authors.initials: S
authors.lastname: Troyanov
authors.forename: David
authors.initials: D
authors.lastname: Geadah
authors.forename: Marc
authors.initials: M
authors.lastname: Ghannoum
authors.forename: Jean
authors.initials: J
authors.lastname: Cardinal
authors.forename: Martine
authors.initials: M
authors.lastname: Leblanc
mesh_terms: D000368:Aged; D005260:Female; D017583:Hemodiafiltration; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006801:Humans; D017674:Hypophosphatemia / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000008:administration & dosage*; D017680:Potassium Compounds / Q000008:administration & dosage*; D017582:Renal Replacement Therapy; D012189:Retrospective Studies
chemical_list: D015312:Hemodialysis Solutions; D010710:Phosphates; D017680:Potassium Compounds; C013216:potassium phosphate