Citrasate Home
Citrasate dialysate contains a small quantity(2.4mEq/L) of citric acid that provides mild anticoagulation where needed, in the extracorporeal circuit, not systemically in the patient.
Citrasate is particularly helpful for hemodialysis patients with:
- H.I.T. Heparin Induced Thomocytopenia
- Heparin antibodies
- Severe clotting problems
- Bleeding risk factors such as; active bleeding, trauma and pre / post surgery
- Citrasate also works well with SLEDD (Sustained, Low-Efficiency, Daily Dialysis)
Citrasate is not a drug, there are no adverse side effects, only improved treatments. There are no changes necessary with your equipment or procedures. Citrasate is used exactly as you would use your standard (acetic acid) dialysate.
Dialysate Composition (mEq/L) |
Regular Dialysate |
Citrasate |
Sodium |
137 |
137.3 |
Chloride |
105.5 |
105.5 |
Calcium |
2.5 |
2.5 |
Magnesium |
1.0 |
1.0 |
Potassium |
2.0 |
2.0 |
Dextros (g/L) |
2.0 |
2.0 |
Acetate (acetic acid) |
4.0 |
0.3 |
Citrate (citric Acid) |
0 |
2.4 |
Bicarbonate |
37 |
37 |
This graph demonstrates how Citrasate differs from regular dialysate. Notice how the composition is very similar for both except for the amount of Acetate and Citrate. Regular dialysate uses Acetate as a "buffer", while Citrasate uses Citrate. It is the Citrate (citric acid) in Citrasate that provides the added anticoagulation benefit. |
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Citrasate is not the same as regional citrate anticoagulation
- Performing citrate dialysis is no different operationally than doing regular bicarbonate dialysis. There is no regional infusion of citric acid employed.
Some anticoagulant (citrate) is in the dialysate.
You do not need to be concerned about hypocalcemia
- The concentration of citrate in Citrasate® is only 2.4 mEq/L; only about one-fifth of the concentration used to achieve anticoagulation via traditional regional citrate infusions. The use of Citrasate® does not produce measurable systemic anticoagulation, the anticoagulant effect is confined to the dialyzer and the venous side of the dialysis set up. Citrasate® generally produces a clinically acceptable transitory reduction (about 10%) in ionized calcium1. Ionized calcium begins to normalize to the pre-dialysis level as soon as the Citrasate® dialysis session stops1. The consistent treatment of chronic dialysis patients with Citrasate® has demonstrated no change over extended time periods in either total or ionized serum calcium levels1.
(1) Ahmad S, Callan R, Cole JJ, Blagg CR. Dialysate made from Dry Chemicals using Citric Acid Increases Dialysis Dose. American Journal of Kidney Diseases 2000; 35: 493-499