Serum phosphorus and the risk of progression of chronic kidney disease.

used due to the blood pressure (BP) levels, we tried another depurative technique. The ECMO system haemofilter was used as dialysis membrane (1.4m poly-ethersulfone membrane; Cobe cardiovascular, Mirandola, Italy). Dialysis fluid was provided by two 5 l bags suspended above the patient (Figure 1). A ‘Y’ tube system was used to deliver a kalium-free dialysate (Na 140mmol/l, bicarbonate 34mmol/l). To control dialysis flow speed, two plastics locks provided by the manufacturer alternatively closed and opened the system. From the filter, another ‘Y’ tube collected the drainage fluid in two 5 l bags below the patient. Each bag was weighed, using an electronic newborn scale, to calculate the ultrafiltration volume. A ‘Y’ line returned the blood from the ECMO: the main branch directly to the patient and the other to the haemofilter. The dialysis flow was maintained at 291ml/min for 2 h and decreased to 83ml/min for 3 h (mean flow 166ml/ min). Patient’s net balance throughout the procedure was zero and temperature 35.58C. After 5 h, BP increased to 76/45, pH to 7.4, kaliemia decreased to 6.2mmol/l, lactate to 8.5mmol/l and bicarbonate remained stable. In the absence of a positive fluid balance, improvement of kaliemia was attributed to dialysis. Improvement of BP could be due to the decrease in potassium levels and the slightly lower core temperature [5]. Lactate decrease was probably due to a better tissue perfusion, rather than a dialytic effect [6]. Gravity dialysis could then be changed to conventional CRRT. In summary, the technique of continuous dialysis by gravity using the ECMO filter could be a therapeutic option in critically unstable patients, unable to tolerate CRRT and requiring urgent management of electrolytic disturbances (Figure 2).