Health professionals responsible for the care of dialysis patients are well aware of the complex relationship between treatment variables and patient outcome. Much depends upon the interaction between the patient's blood and the extracorporeal circuit, especially within the hemodialyzer. Even with systemic heparin anticoagulation, clotting within the dialyzer reduces delivered "dose" of dialysis, increases blood loss, and limits dialyzer reuse. Dialyzer clotting is further accelerated in cases where heparin anticoagulation is contraindicated, for example, in patients with antibodies to this agent. These complications result in additional staff time required to treat the problems, as well as higher costs for additional supplies (dialyzers, blood lines, etc.).
Citrasate® provides improved anticoagulation properties that lead to a higher dose of dialysis (Graph Completed Treatments), superior heparin free treatments and better dialyzer reuse (Citrasate® prevents clotting of fibers). Citrasate® replaces acetic acid (found in regular dialysate) with citric acid, this provides the added benefit of anticoagulation. Performing citrate dialysis is no different operationally than doing regular bicarbonate dialysis. There is no regional infusion of citric acid employed.
You do not need to be concerned about hypocalcaemia. 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 anticoagulation 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 calcium. Ionized calcium begins to normalize to the pre-dialysis level as soon as the Citrasate® dialysis session stops. The consistent treatment of chronic dialysis patients with Citrasate® has demonstrated no change over extended time periods in either total or ionized serum calcium levels.