Intensive Care Medicine

, Volume 30, Issue 8, pp 1662–1665

Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy

  • Stéphan Troyanov
  • David Geadah
  • Marc Ghannoum
  • Jean Cardinal
  • Martine Leblanc
Technical Note

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.

Design and setting

Experimental study with a retrospective observational study in a medico-surgical intensive care unit.

Methods and patients

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.

Measurements and results

Total and ionized calcium, phosphate, pH, PCO2 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.

Keywords

Continuous renal replacement therapy Hypophosphatemia Phosphate Calcium Precipitation 

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Stéphan Troyanov
    • 1
  • David Geadah
    • 2
  • Marc Ghannoum
    • 1
  • Jean Cardinal
    • 1
  • Martine Leblanc
    • 1
  1. 1.Division of Nephrology and Critical Care, Maisonneuve-Rosemont HospitalUniversity of MontrealMontrealCanada
  2. 2.Division of Biochemistry, Maisonneuve-Rosemont Hospital University of MontrealMontrealCanada

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