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Citrate Dialysis Fluid - Gambro Flipbook PDF
A Novel Dialysis Fluid Containing Citrate The benefits for patients of using citrate-containing, acetate-free dialysis f
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Citrate Dialysis Fluid
Novel BiCart Select® Citrate system improves dialysis therapy
A Novel Dialysis Fluid Containing Citrate SelectBag® Citrate is a unique citrate-containing, acetate-free concentrate developed by Gambro for regular hemodialysis and hemodiafiltration treatments. Citrate is a natural metabolite providing both energy and buffering capacity to the patient. In addition, citrate is a well-known antioxidant and anticoagulant. Coagulation activation and oxidative stress lead to increased inflammation, and are identified risk factors for developing cardiovascular disease in dialysis patients. It is a safe and biocompatible alternative to acetate allowing Individualized Quality-assured Dialysis™ (IQD).
The benefits for patients of using citrate-containing, acetate-free dialysis fluid: •
Improved acid-base status
•
Easier electrolyte individualization
•
Less thrombogenic dialysis
•
Reduced inflammation
•
Improved tolerance to treatment
•
Improved efficiency
SelectBag Citrate — A Whole Range of ®
With the BiCart Select® Citrate system it is easy to optimize dialysis fluid composition. SelectBag® Citrate provides an acetate-free dialysis fluid with all the beneficial properties of citrate. Sodium and bicarbonate levels are accurately controlled to your settings, while the SelectBag Citrate container allows you to easily vary calcium, potassium and glucose.
Improved acid-base status
Regular
3.0 Base Excess (mM)
Citrate has buffering capacity and generates bicarbonate in a 3:1 molar ratio when metabolized. Citrate-containing, acetate-free dialysis fluid may reduce pre-dialysis acidosis, with increases in pre-dialysis base excess and bicarbonate levels, without increasing the risk of metabolic alkalosis post dialysis [1, 2].
3.5 Citrate
2.5 2.0 1.5 1.0 0.5 0
Week 2
Week 0
Week 4
Week 6
Increasing pre-dialysis base excess level over 6 weeks using 1.0 mM citrate dialysis fluid instead of regular dialysis fluid [1]
Easier electrolyte individualization Contrary to conventional concentrate delivery systems, the BiCart Select system manages sodium separately through the dry SelectCart cartridge [3]. This allows for individual setting of sodium and bicarbonate in dialysis fluid without concurrent change in potassium, calcium, and magnesium concentrations. The SelectBag Citrate concentrate comes in a variety of potassium and calcium levels and the small box size makes it easy to keep different compositions in stock. The SelectBag label clearly displays the final dialysis fluid concentrations of potassium and calcium to reduce the risk of human error.
Potassium Calcium
Bicarbonate
Sodium
Magnesium
Injured tissue
VASCULAR SPASM Collagen
Injured blood vessel
XII
Less thrombogenic dialysis The SelectBag Citrate system prepares dialysis fluid containing 1 mM citrate. Although not sufficient to provide anticoagulation, the resulting plasma citrate concentration reduces the thrombogenic potential of the extracorporeal circuit. By limiting the availability of calcium ions, citrate dialysis fluid may allow for reduced heparin anticoagulation [4].
INTRINSIC PATHWAY
XIIa XI
EXTRINSIC PATHWAY
PLATELET AGGREGATION
Tissue factor
Ca 2+
XIa IX
Contact activation
Ca 2+
IXa
VIIa
Ca 2+
VII
PF3
PLATELET PLUG COMMON PATHWAY
X
Xa Ca 2+
Prothrombin (II)
Thrombin (IIa) Fibrinogen (I)
CLOT
Fibrin (Ia)
Ca 2+
Citrate binds calcium ions, an essential cofactor of the coagulation cascade
Benefits for Patient Well-being Reduced inflammation 10
0.10 N = 24 p