For patients on CRRT with worsening hyperkalemia despite high replacement fluid rate using a 0 mEq/L potassium bath, do recommend using an additional CRRT machine with separate dialysis access for improved clearance?

Topics: Nephrology • Acute kidney injury

Answer from: at Academic Institution

I think this situation would be unusual. I would first try to optimize everything about the dose of the CRRT. If hyperkalemia persists despite the optimization for a number of hours (it will require a few hours of the change before one sees an effect), the options are: Switch to intermittent hemo...

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at Laredo Medical Center
Look for endogenous release such as necrotic tissu...

Answer from: at Academic Institution

I would use high dose CRRT: typically with our PIRRT dose of 5 liters/hour, but instead of typical PIRRT of 8-10 hours, if need be I would do it continuously, 24 hours, 120 liters a day. I have not had a K I haven't been able to control with that (although I may buy some time with typical medical K ...

Answer from: at Academic Institution

I agree with the answers above, and I will add that it would be unusual to not be able to mitigate enough to the point of considering a second CRRT that it warrants an investigation of the source of the K and whether you are getting recirculation (if this is via a catheter). Even with active K relea...

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