Hypophosphatemia in critically ill patients with acute kidney injury on renal replacement therapies

  • Valentina PistolesiEmail author
  • Laura Zeppilli
  • Enrico Fiaccadori
  • Giuseppe Regolisti
  • Luigi Tritapepe
  • Santo Morabito


Hypophosphatemia is a common but often underestimated electrolyte derangement among intensive care unit (ICU) patients. Low phosphate levels can lead to cellular dysfunction with potentially relevant clinical manifestations (e.g., muscle weakness, respiratory failure, lethargy, confusion, arrhythmias). In critically ill patients with severe acute kidney injury (AKI) renal replacement therapies (RRTs) represent a well-known risk factor for hypophosphatemia, especially if the most intensive and prolonged modalities of RRT, such as continuous RRT or prolonged intermittent RRT, are used. Currently, no evidence-based specific guidelines are available for the treatment of hypophosphatemia in the critically ill; however, considering the potentially negative impact of hypophosphatemia on morbidity and mortality, strategies aimed at reducing its incidence and severity should be timely implemented in the ICUs. In the clinical setting of critically ill patients on RRT, the most appropriate strategy could be to anticipate the onset of RRT-related hypophosphatemia by implementing the use of phosphate-containing solutions for RRT through specifically designed protocols. The present review is aimed at summarizing the most relevant evidence concerning epidemiology, prognostic impact, prevention and treatment of hypophosphatemia in critically ill patients with AKI on RRT, with a specific focus on RRT-induced hypophosphatemia.


Acute kidney injury Critically ill patients CRRT Hypophosphatemia Phosphate-containing solutions RRT 


Author contributions

VP, LZ and SM had the idea for the review, performed the literature search and data analysis, and drafted the work. EF, GR and LT critically revised the work.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Not applicable.


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Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  1. 1.UO Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I“Sapienza” Università di RomaRomeItaly
  2. 2.UOC NefrologiaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  3. 3.Università Cattolica del Sacro CuoreRomeItaly
  4. 4.UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e ChirurgiaUniversità di ParmaParmaItaly
  5. 5.UO Anestesia e Terapia Intensiva in Cardiochirurgia, Azienda Ospedaliero-Universitaria Policlinico Umberto I“Sapienza” Università di RomaRomeItaly

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