Kidney Week

Abstract: TH-PO0730

Dynamic CKRT Dosing Based on Solute Control and Nitrogen Balance: Results from an Institutional Protocol

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Sánchez, Diego, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, CDMX, Mexico

Diego Sánchez, MD

• Avila Villalobos, Sandra Paola, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, CDMX, Mexico

Sandra Paola Avila Villalobos, MD

• Granados, Diana, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, CDMX, Mexico

Diana Granados, MD

• Galindo, Pablo E., Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, CDMX, Mexico

Pablo E. Galindo, MD

Background

Current CKRT dosing recommendations use fixed effluent targets, although metabolic needs change over time. Higher static doses may increase complications. Dynamic dosing may match metabolic demand while limiting overclearance.

Methods

Descriptive study of an institutional dynamic CKRT dosing protocol. Solute control was assessed daily using K, pH, and HCO3. If targets were not met, effluent dose was increased by 20%. If achieved, adjustment was guided by simplified nitrogen balance (NB) and expected protein intake. Dose was increased by 20% for positive NB (>10 g) and decreased by 20% for negative NB (≤−10 g). Solute trajectories and metabolic complications were evaluated.

Results

A total of 138 patients were included. Median CKRT duration was 68.5 hours (IQR 32–129). Most patients received CVVHDF with regional citrate anticoagulation (84%). CKRT solutions averaged K 2 mEq/L and were phosphate-free. Mean delivered dose was 18.56 mL/kg/h (SD 7.56). Hypophosphatemia (<2.5 mEq/L) occurred in 15%, severe hypophosphatemia (<1 mEq/L) in 0.2%, hypomagnesemia in 10%, and hypokalemia in 13%. During the first 48 hours, patients had negative NB with rapid solute and acid–base control. Thereafter, control remained stable, while NB shifted toward neutrality and became positive.

Conclusion

Dynamic CKRT dosing was feasible, allowing early solute control and subsequent dose reduction. Despite phosphate-free, low-K solutions, electrolyte complications were infrequent, and delivered doses were below current recommendations.

K y P trajectories during CKRT

Protein intake (upper), CKRT dose (middle), NB (lowe)