ABSTRACTS from 16th International COnference on ... - CRRT Online

G15
Fluids and Solutions in the Critically Ill 2: Solutions for CRRT
Educational Objectives:
1. Describe the composition of solutions for CRRT
2. Describe the spectrum of solute not replaced during CRRT
3. Describe the complications associated with solution for CRRT
Sean Bagshaw MD, MSc, FRCPC
8:15-9:45
Wednesday, February 15
Content Description:
Solutions for CRRT can be either custom (i.e. compounded in local pharmacy) or commercially prepared.
Commercially prepared solutions are generally safer; however, may be more expensive. There is no practice differences
in the composition of fluids for either replacement and dialysate solutions, except in specific circumstances
(i.e. use of regional citrate anticoagulation [RCA]). In general, CRRT solutions are isotonic and balanced.
The sodium [Na] concentration found in CRRT solutions is generally maintained within the normal physiologic
range, often with varying quantities of additional electrolytes added (i.e. potassium, magnesium, chloride). The
[Na] concentration may need to be adjusted; however, when using RCA or if critically ill patients receiving
CRRT have severe disorders of [Na] balance (i.e. hyponatremia/hypernatremia). Current evidence preferentially
supports the use of bicarbonate [HCO3] as base buffer over lactate or acetate-based solutions. Several additional
electrolytes (i.e. phosphate, glucose), amino acids (i.e. glutamine), trace elements (i.e. thiamine) can be readily
depleted during CRRT and may require supplementation.
Suggested Reading:
1. Tan HK, Uchino S, Bellomo R. The acid-base effects of continuous hemofiltration with lactate or bicarbonate
buffered replacement fluids. Int J Artif Organs. Jun 2003;26(6):477-483.
2. Barenbrock M, Hausberg M, Matzkies F, de la Motte S, Schaefer RM. Effects of bicarbonate- and lactatebuffered
replacement fluids on cardiovascular outcome in CVVH patients. Kidney Int. Oct 2000;58(4):1751-
1757.
3. Tolwani AJ, Prendergast MB, Speer RR, Stofan BS, Wille KM. A practical citrate anticoagulation continuous
venovenous hemodiafiltration protocol for metabolic control and high solute clearance. Clin J Am Soc Nephrol.
Jan 2006;1(1):79-87.
4. Oudemans-van Straaten HM, Bosman RJ, Koopmans M, et al. Citrate anticoagulation for continuous venovenous
hemofiltration. Crit Care Med. Feb 2009;37(2):545-552.
5. Demirjian S, Teo BW, Guzman JA, et al. Hypophosphatemia during continuous hemodialysis is associated
with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant. Nov
2011;26(11):3508-3514.
6. Broman M, Carlsson O, Friberg H, Wieslander A, Godaly G. Phosphate-containing dialysis solution prevents
hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand. Jan 2011;55(1):39-45.
7. Ostermann M, Dickie H, Tovey L, Treacher D. Management of sodium disorders during continuous haemofiltration.
Crit Care. 2010;14(3):418.
8. Celik JB, Topal A, Kartal E, Yosunkaya A. Clinical outcome following the use of inadequate solutions for continuous
veno-venous hemodiofiltration. Ren Fail. 2008;30(10):959-964.
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