Fig. 2

The “HD” arrows showing the three intermittent hemodialysis (HD) sessions initiated in the ICU, with the post-dialysis rebound within hours of termination. CVVHDF with standard pre, post and dialysate flow rates was then introduced with a dialysate, pre- and post-dilution calcium concentration of 1.75 mmol/l. CVVHDF was fine-tuned by optimizing calcium concentrations, lowering them to 0 mmol/l in both the dialysate and predilution solution. The final change involved an increase in dialysate flow rate up to 1500 ml/h. The synergic effect of lowering dialysate and predilution calcium concentrations with the increased dialysate flow rates on normalizing calcemia is made evident (final arrow)