Effect of Continuous Renal Replacement Therapy on Serum Phosphate Level in Patients after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIANCheng ,  GUTian-xiang , LUChun-mao

Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

GUTian-xiang, Email: cmugtx@sina.com

Keywords：

Continuous renal replacement therapy; Hypophosphatemia; Cardiac surgery

DOI：

10.7507/1007-4848.20150165

Video：

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Objective To observe the effect of continuous renal replacement therapy (CRRT) on serum phosphate level in patients after cardiac surgery. Method A single-center retrospective observational study was conducted on 30 patients received CRRT after cardiac surgery. There were 14 males and 16 females with mean age of 57.0±10.8 years (ranged 37-79 years). A total of 16 patients underwent CRRT with continuous veno-venous hemofiltration (CVVH), and 14 patients with continuous veno-venous hemodiafiltration (CVVHDF). The serum phosphate level was measured before treatment, at 24 h, and 48 h during therapy and 24 h after phosphate salt supplementation. Results The level of serum phosphate at 24 h and 48 h during CRRT was decreased (0.6±0.4 mmol/L vs. 0.4±0.2 mmol/L vs. 1.1±0.3 mmol/L, P<0.01). After intravenous phosphate salt supplementation, serum phosphate level got increased (0.6±0.3 mmol/L, P<0.01). There was no statistical difference in serum phosphate level between CVVH and CVVHDF (P>0.05). Conclusion Hypophosphatemia occurs frequently during CRRT, particularly with long treatment time. Phosphate salt supplementation is necessary. The dosage of the supplementation should be adjusted personally based on the regularly monitoring results of serum phosphate tests.

Citation： QIANCheng, GUTian-xiang, LUChun-mao. Effect of Continuous Renal Replacement Therapy on Serum Phosphate Level in Patients after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(7): 650-652. doi: 10.7507/1007-4848.20150165 Copy

1.	Paterson CR. Hypophosphatemia:a dangerous disorder. Nutrition, 1996, 12(728):540.
2.	黎磊石, 刘志红, 主编. 中国肾脏病学. 北京:人民军医出版社, 2008. 1511-1542.
3.	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, 2011, 26(11):3508-3514.
4.	Troyanov S, Geadah D, Ghannoum M, et al. Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy. Intensive Care Med, 2004, 30(8):1662-1665.
5.	Broman M, Carlsson O, Friberg H, et al. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand, 2011, 55(1):39-45.
6.	RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17):1627-1638.
7.	VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med, 2008, 359(1):7-20.
8.	Santiago MJ, López-Herce J, Urbano J, et al. Hypophosphatemia and phosphate supplementation during continuous renal replacement therapy in children. Kidney Int, 2009, 75(3):312-316.
9.	Yi Y, Zhang P, Cui Y, et al. Hypophosphatemia during continuous veno-venous hemofiltration is associated with mortality in critically ill patients with acute kidney injury. Critical Care, 2013, 17(5):R205.
10.	Ashita T. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med, 2012, 367:2505-2514.
11.	承韶晖, 周树生, 王锦权, 等. 连续性血液净化对危重病人血磷水平的影响. 安徽卫生职业技术学院学报, 2010, 9(2):14-15.
12.	肖瑶. 低磷血症的发生及其对机体的影响. 临床和实验医学杂志, 2007, 6(4):161-163.
13.	王平, 杨慧君. 机械通气时低磷血症的发生及临床意义. 中国急救医学, 2002, 22(5):293.
14.	李世军. 低磷血症. 肾脏病与透析肾移植杂志, 2006, 15(5):457-462.
15.	魏桃英, 张劲松. 低磷血症在为重病患者中的发生及其临床意义. 中华临床医学实践, 2007, 6(5):329-331.
16.	Hiremath S, Slivar S, Magner P. Phosphate balance with continuous renal replacement therapy:a simple solution.Am J Kidney Dis, 2013, 62(3):644.
17.	Morabito S, Pistolesi V, Tritapepe L, et al. Regional citrate anticoagulation in CVVH:a new protocol combining citrate solution with a phosphate-containing replacement fluid. Hemodial Int, 2013, 17(2):313-320.
18.	Chua HR, Baldwin I, Ho L, et al. Biochemical effects of phosphatecontaining replacement fluid for continuous venovenous hemofiltration. Blood Purif, 2012, 34(3-4):306-312.
19.	Brown KA, Dickerson RN, Morgan LM, et al. A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support.J Parenter Enteral Nutr, 2006, 30(3):209-214.
20.	Rosen GH, Boullata JI, O'Rangers EA, et al. Intravenous phosphate repletion regimen for critically ill patients with moderate hypophosphatemia. Crit Care Med, 1995, 23(7):1024-1210.

1. Paterson CR. Hypophosphatemia:a dangerous disorder. Nutrition, 1996, 12(728):540.
2. 黎磊石, 刘志红, 主编. 中国肾脏病学. 北京:人民军医出版社, 2008. 1511-1542.
3. 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, 2011, 26(11):3508-3514.
4. Troyanov S, Geadah D, Ghannoum M, et al. Phosphate addition to hemodiafiltration solutions during continuous renal replacement therapy. Intensive Care Med, 2004, 30(8):1662-1665.
5. Broman M, Carlsson O, Friberg H, et al. Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand, 2011, 55(1):39-45.
6. RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med, 2009, 361(17):1627-1638.
7. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med, 2008, 359(1):7-20.
8. Santiago MJ, López-Herce J, Urbano J, et al. Hypophosphatemia and phosphate supplementation during continuous renal replacement therapy in children. Kidney Int, 2009, 75(3):312-316.
9. Yi Y, Zhang P, Cui Y, et al. Hypophosphatemia during continuous veno-venous hemofiltration is associated with mortality in critically ill patients with acute kidney injury. Critical Care, 2013, 17(5):R205.
10. Ashita T. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med, 2012, 367:2505-2514.
11. 承韶晖, 周树生, 王锦权, 等. 连续性血液净化对危重病人血磷水平的影响. 安徽卫生职业技术学院学报, 2010, 9(2):14-15.
12. 肖瑶. 低磷血症的发生及其对机体的影响. 临床和实验医学杂志, 2007, 6(4):161-163.
13. 王平, 杨慧君. 机械通气时低磷血症的发生及临床意义. 中国急救医学, 2002, 22(5):293.
14. 李世军. 低磷血症. 肾脏病与透析肾移植杂志, 2006, 15(5):457-462.
15. 魏桃英, 张劲松. 低磷血症在为重病患者中的发生及其临床意义. 中华临床医学实践, 2007, 6(5):329-331.
16. Hiremath S, Slivar S, Magner P. Phosphate balance with continuous renal replacement therapy:a simple solution.Am J Kidney Dis, 2013, 62(3):644.
17. Morabito S, Pistolesi V, Tritapepe L, et al. Regional citrate anticoagulation in CVVH:a new protocol combining citrate solution with a phosphate-containing replacement fluid. Hemodial Int, 2013, 17(2):313-320.
18. Chua HR, Baldwin I, Ho L, et al. Biochemical effects of phosphatecontaining replacement fluid for continuous venovenous hemofiltration. Blood Purif, 2012, 34(3-4):306-312.
19. Brown KA, Dickerson RN, Morgan LM, et al. A new graduated dosing regimen for phosphorus replacement in patients receiving nutrition support.J Parenter Enteral Nutr, 2006, 30(3):209-214.
20. Rosen GH, Boullata JI, O'Rangers EA, et al. Intravenous phosphate repletion regimen for critically ill patients with moderate hypophosphatemia. Crit Care Med, 1995, 23(7):1024-1210.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of Continuous Renal Replacement Therapy on Serum Phosphate Level in Patients after Cardiac Surgery

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