References & formulas

POST FILTER INFUSION RATE : Volume to be infused in post-dilution to achieve a new net sodium concentration in the effluent, targeting the desired correction. The infusion may be sodium-free or hypertonic, depending on the clinical objective.

Infusion rate =  (([Na] in bags - Target bag net [Na] ) /  (Target bag  net [Na] - [Na] in post filter infusion)) * Total Effluent rate (ml/hr) 

TARGET SODIUM IN BAGS:  The sodium concentration in the bags required to achieve the desired correction. To reach this concentration, bags should be adjusted either by adding/exchanging free water or by adding hypertonic sodium, depending on the objective.

Target sodium in bags = (Desired change in [Na] / 1- (eKt/V) ) + plasma [Na] 

Yessayan LT, Szamosfalvi B, Rosner MH. Management of dysnatremias with continuous renal replacement therapy. Semin Dial. 2021 Nov;34(6):472-479. 

PMID: 34218456.

Yessayan L, Yee J, Frinak S, Szamosfalvi B. Treatment of severe hyponatremia in patients with kidney failure: role of continuous venovenous hemofiltration with low-sodium replacement fluid. Am J Kidney Dis. 2014 Aug;64(2):305-10. 

PMID: 24792353.

Yessayan L, Yee J, Frinak S, Szamosfalvi B. Continuous Renal Replacement Therapy for the Management of Acid-Base and Electrolyte Imbalances in Acute Kidney Injury. Adv Chronic Kidney Dis. 2016 May;23(3):203-10. 

PMID: 27113697.

Rosner MH, Connor MJ Jr. Management of Severe Hyponatremia with Continuous Renal Replacement Therapies. Clin J Am Soc Nephrol. 2018 May 7;13(5):787-789. 

 PMID: 29463598; 

Neyra JA, Ortiz-Soriano VM, Ali D, Morris PE, Johnston CM. A Multidisciplinary Approach for the Management of Severe Hyponatremia in Patients Requiring Continuous Renal Replacement Therapy. Kidney Int Rep. 2018 Sep 13;4(1):59-66. 

PMID: 30596169;