a Dialysis Center , Konkuk University Medical Center , Seoul , Korea.
b Department of Cellular and Molecular Medicine , Konkuk University School of Medicine , Seoul , Korea.
Ren Fail. 2019 Nov;41(1):72-79. doi: 10.1080/0886022X.2018.1561374.
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.
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).
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.
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.
在危重病患者的连续肾脏替代治疗（CRRT）中，低磷血症很常见，可导致全身肌肉无力、呼吸衰竭延长和心肌功能障碍。本研究旨在探讨在危重病患者的强化 CRRT 中，向透析液和置换液中添加磷酸盐以治疗低磷血症的疗效和安全性。
我们回顾性分析了在重症监护病房接受强化 CRRT（流出液流速≥35ml/kg/hr）的 73 名患者。对照组（组 1，n=22）未补充磷酸盐。治疗组分别接受 2.0mmol/L（组 2，n=26）或 3.0mmol/L（组 3，n=25）的透析液和置换液磷酸盐补充。
CRRT 引起的低磷血症发生率为 59.0%。用磷酸盐补充纠正低磷血症使组 2 和组 3 的血清磷水平分别变为 1.24±0.37mmol/L 和 1.44±0.31mmol/L（p=0.02）。组 2 和组 3 纠正所需的时间分别为 1.65±0.80 天和 1.39±1.43 天，组 2 明显更长（p=0.02）。补充后，组 2 有 7%发生低磷血症和高磷血症，组 3 无低磷血症，但有 20%发生高磷血症。高磷血症病例在停止磷酸盐补充后 2.0 天（组 2）和 1.0 天（组 3）内血清磷水平恢复正常。
磷酸盐补充有效纠正了急性肾损伤危重病患者的 CRRT 诱导性低磷血症。在 CRRT 诱导性低磷血症患者中使用 2mmol/L 磷酸盐是合适的，但在开始 CRRT 时可能需要不同的浓度来预防低磷血症。
