• Kevin D McBryde, Timothy E Bunchman, Timothy L Kudelka, Deborah A Pasko, and Patrick D Brophy.
• Department of Pediatrics, Children's National Medical Center, The George Washington University, Washington, DC, USA.
• Pediatr Crit Care Me. 2005 Mar 1; 6 (2): 220-5.

ObjectiveTo 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.Data SourceAn Institutional Review Board-approved pediatric acute renal failure database at the University of Michigan C. S. Mott Children's Hospital.Study SelectionThree 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.Data ExtractionThe 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.Data SynthesisThe 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.ConclusionsHyperosmolar 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.

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