Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Treatment dose and the elimination rates of electrolytes, vitamins, and trace elements during continuous veno-venous hemodialysis (CVVHD)



During continuous renal replacement therapy, achievement of recommended treatment dose is important. However, relevant substrate loss may occur and recommended nutrition during critical illness could not be sufficient for higher dialysis doses. We investigated the correlation of dialysis dose and substrate loss for a broad range of dialysis doses.


Forty critically ill patients with acute kidney injury undergoing citrate CVVHD were included in this prospective study. Three different corresponding blood flow (BF) and dialysate flow (DF) rates were applied (BF/DF: 100 ml/min, 2000 ml/h; 80 ml/min, 1500 ml/h; 120 ml/min, 2500 ml/h). Delivered effluent flow rate (DEFR) was calculated and correlated with losses of vitamins, electrolytes, and trace elements during recommended nutritional supplementation.


For folic acid, vitamin B12, zinc, inorganic phosphate, and magnesium, no correlation of losses and DEFR was detected. For ionized calcium, a correlation was observed and additional substitution was required.


Clinically relevant loss of folic acid, vitamin B12, zinc, inorganic phosphate, and magnesium was not observed for differently used dialysis doses of CVVHD, and the loss was covered sufficiently by daily recommended nutritional supplementation. Increased loss of ionized calcium for higher dialysis doses occurred during citrate CVVHD. Therefore, a strict protocol must maintain calcium homeostasis to avoid calcium depletion.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Fayad AI, Buamscha DG, Ciapponi A (2016) Intensity of continuous renal replacement therapy for acute kidney injury. Cochrane Database Syst Rev 10:cd010613.

  2. 2.

    Mehta RL, McDonald BR, Aguilar MM, Ward DM (1990) Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients. Kidney Int 38(5):976–981

  3. 3.

    Morgera S, Schneider M, Slowinski T, Vargas-Hein O, Zuckermann-Becker H, Peters H, Kindgen-Milles D, Neumayer H-H (2009) A safe citrate anticoagulation protocol with variable treatment efficacy and excellent control of the acid-base status. Crit Care Med 37(6):2018–2024.

  4. 4.

    Palsson R, Niles JL (1999) Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding. Kidney Int 55(5):1991–1997.

  5. 5.

    Overberger P, Pesacreta M, Palevsky PM (2007) Management of renal replacement therapy in acute kidney injury: a survey of practitioner prescribing practices. Clin J Am Soc Nephrol 2(4):623–630.

  6. 6.

    Churchwell MD, Pasko DA, Btaiche IF, Jain JC, Mueller BA (2007) Trace element removal during in vitro and in vivo continuous haemodialysis. Nephrol Dial Transplant 22(10):2970–2977.

  7. 7.

    Pasko DA, Churchwell MD, Btaiche IF, Jain JC, Mueller BA (2009) Continuous venovenous hemodiafiltration trace element clearance in pediatric patients: a case series. Pediatr Nephrol (Berlin Germany) 24(4):807–813.

  8. 8.

    Datzmann T, Träger K, Reinelt H, von Freyberg P (2017) Elimination rates of electrolytes, vitamins, and trace elements during continuous renal replacement therapy (CRRT) with citrate CVVHD—influence of filter lifetime. Blood Purif 44(3):210–216.

  9. 9.

    Berger MM, Shenkin A, Revelly J-P, Roberts E, Cayeux MC, Baines M, Chiolero RL (2004) Copper, selenium, zinc, and thiamine balances during continuous venovenous hemodiafiltration in critically ill patients. Am J Clin Nutr 80(2):410–416

  10. 10.

    Section 2: AKI Definition (2012) Kidney Int Suppl 2(1):19–36.

  11. 11.

    Biesalski HK, Bischoff SC, Boehles HJ, Muehlhoefer A (2009) Water, electrolytes, vitamins and trace elements: guidelines on parenteral nutrition, Chapter 7. German Med Sci 7:Doc21.

  12. 12.

    Lee JW (2010) Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press 8(2):72–81.

  13. 13.

    Lamers Y (2011) Indicators and methods for folate, vitamin B-12, and vitamin B-6 status assessment in humans. Curr Opin Clin Nutr Metab Care 14(5):445–454.

  14. 14.

    Berger MM, Shenkin A (2007) Trace element requirements in critically ill burned patients. J Trace Elem Med Biol 21(Suppl 1):44–48.

  15. 15.

    Klein CJ, Moser-Veillon PB, Schweitzer A, Douglass LW, Reynolds HN, Patterson KY, Veillon C (2002) Magnesium, calcium, zinc, and nitrogen loss in trauma patients during continuous renal replacement therapy. JPEN J Parenter Enteral Nutr 26(2):77–92 discussion 92–73

  16. 16.

    Tolwani A, Wille KM (2012) Advances in continuous renal replacement therapy: citrate anticoagulation update. Blood Purif 34(2):88–93.

  17. 17.

    Davenport A, Tolwani A (2009) Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit. NDT Plus 2(6):439–447.

  18. 18.

    Oudemans-van Straaten HM, Ostermann M (2012) Bench-to-bedside review: citrate for continuous renal replacement therapy, from science to practice. Crit Care 16(6):249.

  19. 19.

    Wang PL, Meyer MM, Orloff SL, Anderson S (2004) Bone resorption and “relative” immobilization hypercalcemia with prolonged continuous renal replacement therapy and citrate anticoagulation. Am J Kidney Dis 44(6):1110–1114

  20. 20.

    Section 5: Dialysis Interventions for Treatment of AKI (2012). Kidney Int Suppl (2011) 2(1):89–115.

  21. 21.

    Prowle JR, Schneider A, Bellomo R (2011) Clinical review: optimal dose of continuous renal replacement therapy in acute kidney injury. Crit Care 15(2):207.

  22. 22.

    Venkataraman R, Kellum JA, Palevsky P (2002) Dosing patterns for continuous renal replacement therapy at a large academic medical center in the United States. J Crit Care 17(4):246–250.

Download references


The authors would like to acknowledge the support of Gerald Steinbach from the Department of Clinical Chemistry at the University Hospital Ulm.

Author information

Correspondence to Thomas Datzmann.

Ethics declarations

Conflict of interest

Karl Träger received honoraria for lectures from Fresenius Medical Care.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Datzmann, T., Träger, K., Schröppel, B. et al. Treatment dose and the elimination rates of electrolytes, vitamins, and trace elements during continuous veno-venous hemodialysis (CVVHD). Int Urol Nephrol 50, 1143–1149 (2018).

Download citation


  • Acute kidney injury
  • Continuous renal replacement therapy
  • Citrate anticoagulation
  • Critical illness
  • Trace elements