title: Preventing Continuous Renal Replacement Therapy-Induced Hypophosphatemia: An Extended Clinical Experience with a Phosphate-Containing Solution in the Setting of Regional Citrate Anticoagulation.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a commercially available phosphate-containing solution for continuous renal replacement therapy (CRRT) in preventing CRRT-related hypophosphatemia.
  
  
  METHODS
  In heart surgery patients undergoing continuous veno-venous haemodiafiltration (CVVHDF) with regional citrate anticoagulation (RCA), we combined an 18 mmol/l citrate solution with a phosphate-containing (1.2 mmol/l) dialysate/replacement fluid evaluating the incidence of hypophosphatemia and the need for parenteral phosphorus supplementation.
  
  
  RESULTS
  In 75 patients on RCA-CVVHDF, the mean filter life was 53.9 ± 33.6 h. Regardless of baseline levels, phosphoremia was progressively corrected and maintained in a narrow normality range throughout RCA-CRRT days (after 72 h: 1.14 ± 0.25 mmol/l). Considering the whole CRRT period, 45 out of 975 (4.6%) serum phosphorus determinations met the criteria for mild (<0.81 mmol/l) or moderate (<0.61 mmol/l) hypophosphatemia; severe hypophosphatemia (<0.32 mmol/l) never occurred. After 72 h 88% of the patients were normophosphatemic, 9% hyperphosphatemic and 3% hypophosphatemic.
  
  
  CONCLUSIONS
  RCA-CVVHDF with a phosphate-containing solution enabled the maintenance of phosphorus levels within normophosphatemic range in most of the patients, minimizing the occurrence of CRRT-related hypophosphatemia.
authors.affiliation: Department of Nephrology and Urology, Hemodialysis Unit, Policlinico di Roma, 'Sapienza' University, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pistolesi
authors.forename: Laura
authors.initials: L
authors.lastname: Zeppilli
authors.forename: Francesca
authors.initials: F
authors.lastname: Polistena
authors.forename: Maria Itala
authors.initials: MI
authors.lastname: Sacco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pierucci
authors.forename: Luigi
authors.initials: L
authors.lastname: Tritapepe
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Regolisti
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiaccadori
authors.forename: Santo
authors.initials: S
authors.lastname: Morabito
mesh_terms: D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000379:methods; D002951:Citrates; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010710:Phosphates; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002951:Citrates; D015314:Dialysis Solutions; D010710:Phosphates