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Citrate Anticoagulation Treatment in Haemodialysis Therapy

Since the 1960s anticoagulation with Citrate solutions is known and since 1980 it is used for clinical applications. It is used for blood anticoagulation in extracorporeal circulation as an alternative for patients allergic to Heparin and in operative intensive car to reduce bleeding risk during surgery. The principle involved is simple: Sodium Citrate is a Chelate formator and builds with multiple positive charged electrolyts (Ca2+, Mg2+) an insoluble complex. The level of ionized calcium is reduced and blood coagulation inhibited. Approx. 50% of this citrate calcium complex is eliminated by dialysate before the rest is undergoing metabolism via citric acid cycle of liver, kidney and skeletal muscles converted into bicarbonate. Neutralisation of hemodilution is then neutralized by addition of intravenous calcium solution.

Arguments at First View:

  • natural Metabolite – easily metabolized in the liver
  • effect of Antigulant only in extracorporeal circulation
  • no adverse effects, increased survival (studies)
  • extension of service life of dialysis filters

Sodium Citrate 4 %, 14,7 %, 35,3 % 

ProductSizeComposition of Solution In MMOL/Lg/lPH-VALUE
Sodium Citrate 4 % 1.000 ml 136 40 6,4 - 7,5
Sodium Citrate 4 % 1.500 ml 136 40 6,4 - 7,5
Sodium Citrate 4 % 2.000 ml 136 40 6,4 - 7,5
Sodium Citrate 14,7 % (0,5 M) 500 ml 500 147 6,4 - 7,5
Sodium Citrate 35,3 % (1,2 M) 250 ml 1.200 353 6,4 - 7,5

 

SOLUTIONS FOR CITRATE-ANTICOAGULATION

Product Citralysate
Calciumfree
double chamber bag 5.000 ml		Na+
mmol/l		K+
mmol/l		Ca++
mmol/l		Mg++
mmol/l		CI-
mmol/l		HCO3-
mmol/l		Glucose
g/l		PH-Value
Citralysate K0 133 0,0 0 0,75 116,5 0,75 1,0 7,0 - 9,0
Citralysate K2 133 2,0 0 0,75 116,5 20 1,0 7,0 - 9,0
Citralysate K4 133 4,0 0 0,75 116,5 20 1,0 7,0 - 9,0

 

PLUS SOLUTIONS FOR CITRATE-ANTICOAGULATION

Produkt Citralysate
Calciumfree
double chamber bag 5.000 ml		Na+
mmol/l		K+
mmol/l		Ca++
mmol/l		Mg++
mmol/l		CI-
mmol/l		HCO3-
mmol/l		Glucose
g/l		PH-Value
Citralysate K2 plus 133 2,0 1,0 115,75 20 1,25 1,0 7,4
Citralysate K4 plus 133 4,0 1,0 117,75 20 1,25 1,0 7,4

 

LACTOCITRATE

Lactocitrate is a newly developed and patented lactate-buffered dialysate which is extremely well-suited for combination with citrate CRRT. For example Lactocitrate contains a normal level of magnesium thus reducing such as arrhythmias, myopathie caused by magnesium deficiency. Furthermore Lactocitrate contains phosphate, which lacks in Standard CRRT solutions. CRRT therapy however indicates at early stage continuous phosphate substitution to avoid hypophosphatemia. The single chamber bag 5.000 ml Citrate can be used in balanced with the standard market machines. The bag is equipped with the usual connectors for all standard hemofiltration machines. In addition the single-chamber bag allows long stability.

Product Lactocitrat
One Chamber Bag 5.000 ml		Na+K+
mmol/l		Mg2+ mmol/lCI-
mmol/l		H2PO4-
mmol/l		Glucose
mmol/l		Laktat mmol/lPH- Value
Lactocitrate 130 2,0 1,5 116 1,0 5,6 18,0 6,8

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