Citrasate Helpful Hints
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Make sure you are using the correct dilution (36.83X, 45X, or 35X):
Refer to your current acid concentrate label for the correct dilution.
Dialysate flow can affect Citrasate’s anticoagulation benefits:
With a higher dialysate flow rate (600, 700, 800) more citrate, in relation to the blood, passes through the dialyzer,
thus providing more anticoagulation. With SLEDD treatments, longer clot free runs have been achieved when the dialysate flow is at least 175% of the blood flow rate.
Be sure to run the Citrasate dialysate through the dialyzer prior to starting the treatment, as this will “coat” the
dialyzer with citric acid to aid in anticoagulation.
Citrasate may be used in conjunction with heparin:
The use of Citrasate and heparin together may produce superior anticoagulation results vs. heparin alone.
Citrasate and patients with advanced liver failure:
The low citrate concentration (2.4mEq/L) in Citrasate, coupled with citrate metabolism in the muscles produces no
evidence of citrate accumulation in the patient. Abstract available at www.citrasate.com/references
Citrasate and Catheter patients:
Temporary Catheters may diminish the effectiveness of Citrasate because they require low flow rates (max 200 -
300), are hard to use and tend to kink easily.
Citrasate is a dialysate concentrate.
Citrasate is not a catheter “lock”.
Storing unused Citrasate:
Unused Citrasate should be kept in a sealed container and can be used up to the expiration date on the label
Citrasate may be “spiked” with potassium or calcium:
Please refer to your additive supplier’s directions or click here for more information.
Conductivity alarm with Gambro Phoenix machines:
You might experience conductivity alarms with Gambro Phoenix dialysis machines, caused by a slight pH
difference (higher) in Citrasate dialysate. NOTE: No other machine has this issue.
The problem is with the machine setting, not Citrasate. There is a circuit board setting in the machine that can be
adjusted to the “upper” 7.8 pH range. Contact your Gambro technician to adjust the setting.
Citrasate may not work on all patients:
A 75 - 80% success rate with heparin-free treatments has been routinely achieved in clinical studies.
• For example, in one published study with regular dialysate, about 24% of acute patients treatments were completed
compared to 76% not completed due to clotting in the extracorporeal circuit. With CITRASATE®, a statistically significant 78% of the treatments were completed. Hence, CITRASATE® treatment dramatically improves and simplifies clinical treatment in this high-risk patient group (Tu A, Ahmad S, Heparin-free hemodialysis with citrate containing dialysate in intensive care patients. Dial Transplant. 2000; 29(5): 991-999.)
Not all dialyzers are created equal:
With the REXEED dialyzer, Asahi has achieved a new level of overall performance in dialyzer design by combining
the new polysulfone membrane, REXBRANE, with a new jacket design allowing for optimum flow dynamics. Incorporated on the inner surface is Asahi’s unique hydrophilic gel layer technology. This minimizes blood membrane interaction and plays a crucial roll in ANTICOAGULATION requirements, LESS HEPARIN!!