Management of Hyperkalemia Despite CRRT in Severe Leukocytosis

Optimizing CRRT Parameters

• The Kidney International recommends verifying CRRT is functioning properly with adequate blood flow rates, ensuring dialysate/replacement fluid has low or zero potassium concentration, and considering increasing CRRT dose/intensity if current prescription is inadequate in patients with true hyperkalemia despite CRRT 1, 2, 3

Adjusting CRRT Electrolyte Composition

• The Kidney International suggests using commercial CRRT solutions with appropriate electrolyte composition, specifically solutions with minimal or no potassium, and avoiding exogenous intravenous potassium supplementation in CRRT patients 4, 5
• It is recommended to maintain magnesium levels ≥0.70 mmol/L through dialysate composition rather than IV supplementation, as hypomagnesemia causes refractory hyperkalemia 4, 5

Monitoring Strategy

• The Praxis Medical Insights guideline recommends monitoring magnesium, calcium, and phosphate daily, targeting magnesium ≥0.70 mmol/L and phosphate >0.81 mmol/L through CRRT solution composition 5