Continuous renal replacement therapy (CRRT) remains the standard treatment for critically ill patients with acute kidney injury (AKI). Electrolyte disturbance like hypokalemia or hypophosphatemia is paradoxically reported in patients undergoing CRRT due to high clearance. A recent study developed a fluid management protocol for dialysate and replacement fluid that depends on serum electrolytes and focuses on potassium and phosphate levels to prevent electrolyte disturbance during CRRT. It then evaluated the impact of the new fluid protocol on electrolyte stability.

The study included adult patients who received CRRT between 2013 and 2017. It compared Patients treated two years before (pre-protocol group) and two years after the development of the fluid protocol (protocol group). The study looked for an individual coefficient of variation (CV) and abnormal event rates of serum phosphate and potassium, as well as the frequency of electrolyte replacement and incidence of cardiac arrhythmias. It analyzed Individual CV and abnormal event rates for each electrolyte.

The study observed-

• Inclusion of 1,448 patients.
• Higher serum phosphate and potassium in the protocol group.
• Significantly lower CVs of serum phosphate and potassium in the protocol group.
• Significantly lower abnormal event rates of serum phosphate and potassium in the protocol group.

This study proves that protocolized fluid management in CRRT can effectively prevent hypophosphatemia and hypokalemia by inducing excellent stability of serum phosphate and potassium levels.

Front. Med. 9:915072. doi: 10.3389/fmed.2022.915072