Advanced Renal Technologies - Citrasate and DRYalysate citrate dialysate

Articles and Abstracts

Citrasate® liquid A concentrate dialysate and DRYalysate® dry dialysate powder represent the first major change in dialysate chemical composition in 30 years. The use of citric acid instead of acetic acid as the acidifier in the dialysate has been shown to produce better dialysis therapy by increasing the dialysis dose. And because citrate dialysate can reduce clotting and increase dialyzer reuse, it can save clinics time and money. The following articles and abstracts speak to these benefits.

1. Abstract: Citrate dialysate (Citrasate®) in SLEDD is safe and effective in the presence of severe liver dysfunction. Ahmad, S., Tu, A., Division of Nephrology, University of Washington, Seattle Wash. Long slow dialysis using Citrasate® was successfully completed in 94% of the acute dialysis treatments for at least 6 hours without clots despite not using heparin on these advanced liver failure patients. Citrasate® used for extended SLEDD treatments of as long as 24 hours duration was safe without any evidence of citrate accumulation or development of hypocalcemia in hepatic failure. Thus citrate dialysate (Citrasate®) in SLEDD is safe and effective in presence of severe liver dysfunction. Presented at the European Renal Association and European Dialysis and Transplant Association congress, Barcelona, Spain, June 2007.
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2. Abstract: Heparin Free Slow Low Efficiency Dialysis (SLED) Using Citrate Dialysate (CD) Is Safe and Effective. S. Ahmad, A. Tu, Department of Medicine, University of Washington, Scribner Kidney Center, Seattle, Wash., USA. Presented at the 12th International Conference on Continuous Renal Replacement Therapies (CRRT) March 7–10, 2007, San Diego, Calif.
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3. Abstract: The use of citrate dialysate (Citrasate®) along with a 55% reduction in heparin was successful in decreasing the episodes of prolonged bleeding, was not associated with clotting of the system and an adequate dose of dialysis was maintained. Kossmann, R. Nephrophiles, LLC (Fresenius Medical Care), Santa Fe, New Mexico, USA; Callan, R., Advanced Renal Technologies, Bellevue, Wash. USA; Ahmad, S., Division of Nephrology, University of Washington, Seattle Wash. USA Fifty-five percent heparin reduction is safe with citrate dialysate in chronic dialysis patients. Submitted to the American Society of Nephrology for presentation at ASN’s 39th Annual Renal Week Meeting, San Diego, Calif., USA, November 2006.
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4. Abstract: The anticoagulation effect of citrate dialysate (Citrasate®) keeps the dialyzer fibers and pores open and is responsible for the increased removal of urea and beta-2 microglobulin. Kossmann, R. Nephrophiles, LLC (Fresenius Medical Care), Santa Fe, New Mexico, USA; Callan, R., Advanced Renal Technologies, Bellevue, Wash. USA; Ahmad, S., Division of Nephrology, University of Washington, Seattle Wash. USA Increased dialysis dose and decreased concentration of beta-2 microglobulin with citrate dialysate. Submitted to the American Society of Nephrology for presentation at ASN’s 39th Annual Renal Week Meeting, San Diego, Calif., USA, November 2006.
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5. Abstract: Citrate dialysate (CD) is well tolerated in patients with advanced liver failure and bleeding risk, and CD resolves the dilemma of anticoagulation in these patients. Ahmad, S., Tu, A., Division of Nephrology, University of Washington, Seattle Wash. Heparin-free citrate dialysis in end stage liver disease (ESLD) patients is well tolerated. Presented at the European Dialysis and Transplant Nurses Association congress, Madrid, Spain, September 2006.
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6. Abstract: The use of citrate dialysate (CD) permitted a significant reduction in heparin (30% reduction) without any increase in clotting during the treatment, and without any decrease in the dose of dialysis as determined by Kt/V (urea). Ahmad, S., Division of Nephrology, University of Washington, Seattle Wash.; Callan, R., Advanced Renal Technologies, Bellevue, Wash.; Kossmann, R., Nephrophiles, LLC (Fresenius Medical Care), Santa Fe, New Mexico, USA. Heparin reduction with citrate dialysate. Presented at the European Renal Association – European Dialysis and Transplant Association congress, Glasgow, Scotland, July 2006, and published in Nephrology Dialysis Transplantation, Volume 21 Supplement 4 2006.
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7. Stated conclusion: “The use of Citrasate® in SLEDD or conventional hemodialysis treatments is an excellent alternative for an anticoagulant when heparin cannot be utilized.” Isaacs, P. Personal communication, April 2006.
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8. Stated conclusion: “Citrasate® was more effective in maintaining the circuit than saline flushes, and appears to be safe for use in SLEDD in critically ill patients.” Madison, J., Depner, T., Chin, A., Division of Nephrology, University of California Davis Medical Center, and Renal Services Program, University of California Davis Medical Center, Sacramento, Calif., USA. Alternatives to heparin anticoagulation during slow extended daily dialysis in the ICU. Presented at the National Kidney Foundation Clinical Nephrology 2006 Meeting, Chicago, April 2006.
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9. Stated conclusion: “Citrasate® was more effective than saline flushes alone, at completing anticoagulant-free SLEDD treatments in the ICU. We observed significantly less clotting events in those on Citrasate® compared to those receiving saline flushes. Use of Citrasate® required significantly less frequent flushing of dialysis circuits and thereby reduced nursing time.” Madison, J., Ilumin, M., Chin, A., Division of Nephrology, University of California Davis Medical Center, and Renal Services Program, University of California Davis Medical Center, Sacramento, Calif., USA. Citrate-containing dialysate is well tolerated during slow extended daily dialysis in the ICU. Presented at the American Society of Nephrology, 38th Annual Renal Week Meeting, Philadelphia, Penn., USA November 2005.
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10. Stated conclusion: “The results from this study show that citric acid-containing dialysate is associated with increase in dialyzer reuse and appears to be related to reduced clotting.” Ahmad S, Callan R, Cole JJ, Blagg CR Increased dialyzer reuse with citrate dialysate. Hemodialysis International 2005; 9: 264-267

11. 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.
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12. 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.

13. 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.
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14. 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.

15. 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.
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16. U.S. FOOD AND DRUG ADMINSTRATION 2006 Safety Alert: Heparin
Heparin Sodium Injection [Posted 12/08/2006] FDA notified healthcare professionals of revisions to the WARNINGS section of the prescribing information for Heparin to inform clinicians of the possibility of delayed onset of heparin-induced thrombocytopenia (HIT), a serious antibody-mediated reaction resulting from irreversible aggregation of platelets. HIT may progress to the development of venous and arterial thromboses, a condition referred to as heparin-induced thrombocytopenia and thrombosis (HITT). Thrombotic events may be the initial presentation for HITT which can occur up to several weeks after the discontinuation of heparin therapy. Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT and HITT.
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