Hyperosmolar solutions in continuous renal replacement therapy for hyperosmolar acute renal failure: A preliminary report*

Abstract

To demonstrate the efficacy of hyperosmolar dialysis and prefilter replacement fluid solutions for continuous renal replacement therapies in the correction of hyperosmolar disorders in acute renal failure. An Institutional Review Board-approved pediatric acute renal failure database at the University of Michigan C. S. Mott Children's Hospital. Three patients were identified meeting the inclusion criteria. The mean serum sodium concentration and plasma osmolality were 158 mmol/L and 357 mOsm/kg, respectively, at the time of initiation of renal replacement therapy. The sodium and/or dextrose concentrations of the dialysate or replacement fluids initially were increased and subsequently decreased to affect the solutions' calculated osmolalities in an effort to control the rate of decline of the patients' measured plasma osmolalities. The case patients' serum sodium concentrations and plasma osmolalities were measured. Additionally, the sodium and dextrose concentrations of the dialysate or replacement fluid were recorded and the solutions' osmolalities calculated. The three patients experienced a mean rate of reduction of their serum sodium concentration and plasma osmolality of 0.5 mmol/L/hr and 1.6 mOsm/kg/hr, respectively. Hyperosmolar dialysis or prefilter replacement fluid solutions can affect a slow decline in both the serum sodium and plasma osmolality in cases of hyperosmolar acute renal failure.