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Acid concentrate to make 2.4 mEq/L citrate-containing bicarbonate dialysis solution

Citrasate® is acid concentrate for bicarbonate-based dialysis solution. Citric acid instead of acetic acid is the primary acidifying agent. DRYalysate® is a similar product in powder form.

Even though the amount of citrate used is very small, the 2.4 mEq/L citrate in the final dialysate may inhibit blood coagulation locally at the dialyzer membrane surface, resulting in better dialyzer clearance and increased reusability. Heparin use is still recommended, although heparin-free dialysis with Citrasate® has been reported to give good results with less need for periodic saline flushing.

Advanced Renal Technologies provides an advanced dialysis fluid (dialysate) formulation containing citric acid--the first major change in dialysate chemical composition in 25 years.

Making the change to Citrasate® is Easy and Safe:

Cleared for clinical use by the FDA

No modification to existing bicarbonate-machines required – replaces the standard A concentrate (35X, 36.83X or 45X)

Very low citrate level does not normally affect systemic coagulation times or ionized blood calcium levels

reduces dialyzer clotting and increases dialyzer reuse, saving clinics time and money.

1. Stated conclusion: "Using dialysate containing citric instead of acetic acid increases the delivered dialysis dose." Ahmad S, Callan R, Cole JJ, Blagg CR. Dialysate made from dry chemicals using citric acid increases dialysis dose. Am J Kidney Dis. 35(3):493-499, 2000. Read Abstract from PubMed

2. Stated conclusion: "The use of citrate dialysate was associated with significantly less clotting than the regular dialysate, and can be a safe alternative to heparin in patients with high bleeding risk or who are intolerant to heparin." Tu A, Ahmad S. Heparin-free hemodialysis with citrate-containing dialysate in intensive care patients. Dial Transplant. 29(10):620-626, 2000. Read Full Article

3. Abstract: Increased dialyzer efficiency using a dialysate containing citric acid in place of acetic acid. Ahmad S, Callan R, Cole JJ, Blagg CR. Div. of Nephrology, University of Washington, Seattle, Wash.; Advanced Renal Technologies, Inc., Kirkland, Wash. Presented at the meeting of the American Society of Nephrology, Miami, Fla., November 1999. View Poster Presentation

4. Abstract: Heparin-free acute dialysis using citrate dialysate--this experience with citrate dialysate suggests it to be superior to regular dialysate in patients with a high risk of bleeding. Tu A, Ahmad S. Div. of Nephrology, University of Washington, Seattle, Wash. Presented at the meeting of the American Society of Nephrology, Toronto, Ontario, Canada, October 2000. View Poster Presentation

5. Presentation Summary: Effect of citrate-containing dialysate on dialyzer reuse--results indicate that citrate dialysate reduces clotting of fibers and enables a significantly higher number of dialyzer reuses. Ahmad S, Callan R, Cole JJ, Blagg CR. Div. of Nephrology, University of Washington, Seattle, Wash.; Advanced Renal Technologies, Inc., Kirkland, Wash. Presented at the meeting of the American Society of Nephrology, Toronto, Ontario, Canada, October 2000. View Abstract

Citrasate® dialysate can raise average dialyzer reuse by more than 60% on all patients, and by over 100% on patients considered "problem clotters." Consequently, for the facility seeking to cut operating costs, ART's citrate dialysate is an effective solution. (ref. 4)

Citrasate® dialysate can be used for heparin-free dialysis of patients with antibodies to heparin. (ref. 1, 5) Where heparin anticoagulation is contraindicated, citrate dialysate can be used for dialysis of patients with acute renal failure who are at risk of bleeding. In most cases, citrate dialysate reduces or eliminates the need to flush the extracorporeal circuit with saline. (ref. 5)

Citrasate® dialysate increases the delivered "dose" of dialysis for the patient, including improved Kt/V and URR and increased predialysis serum bicarbonate levels. (ref.3)

Stated conclusion: "Using dialysate containing citric instead of acetic acid increases the delivered dialysis dose." Ahmad S, Callan R, Cole JJ, Blagg CR. Dialysate made from dry chemicals using citric acid increases dialysis dose. Am J Kidney Dis. 35(3):493-499, 2000.