catálogo citrasate rev 07-2013 eng - nipro renal solutions · there is a 55% reduction of heparin...

Hypotension

Intolerance

• Elderly patients.• 21.5% diabetes mellitus (first cause of CKD in patients between 45 and 75 years old).• First therapeutic option: Hemodialysis (85.1%).

2009 Spanish Registry for Kidney Diseases. www.senefro.org

Hemodialysis Treatment for Acute and Chronic Renal Failure

• Vascular resistance incorrect adjustment: vasodilatation

• Myocardial Depression• Arrhythmia

Pol. Ind. TUMSA - Nave nº 31 · E-25230 Mollerussa · Lleidawww.niprorenalsolutions.com

CITRASATE® is a trademark of Advanced Renal Technologies

Rev: 07/2013

ACID CONCENTRATE FOR HEMODIALYSISMINIMUM ACETATE CONCENTRATION

CITRASATE®CITRASATE®

COMPATIBLE WITH ALL TYPES OF MACHINESIMPROVES HEMODYNAMIC TOLERANCE

LOWER INFLAMATORY RESPONSEINCREASES DIALYSIS EFFICIENCYIMPROVES ACIDOSIS ADJUSTMENT

CLOTTING PREVENTION

MAIN ADVANTAGES

ACETATE EFFECTS ON THE DIALYSIS BATH

CURRENT POPULATION

CURRENT OPTIONS FOR HEMODIALYSIS

CITRASATE®

• Biofiltration• Hemodialysis without acetate: • AFB • Online PHF • With HCl• Online Hemodiafiltration

Disadvantages:• They require special machines increasing

treatment cost• They cannot be used with all population

CITRASATE® is an acid concentrate for hemodialysis with a minimum concentration of acetate substituting acetic acid for citric acid.

SUITABLE FOR:

Elderly PatientsDiabetic Patients

Patients with a Cardiovascular PathologyCritical Patients or Bleeding Risk in Patients

Patients with Heparin Antibodies

Incorrect Dialysis: dosagePrescribed Dialysis ≠ dosageAdministered Dialysis

ACETATE

ONLY

mEq/l

0,3Conventional Hemodialysis MachineImproved Hemodynamic ToleranceLower Inflammatory ResponseDialysis Higher EfficiencyImproved Correction of Acidosis Lower Heparin Dosage

RENAL SOLUTIONS

Blood coagulation when in contact with the dialyzer reduces its effective surface and reduces its efficiency.

Citric Acid forms complexes with the blood Ca2+ redu-cing the necessary Ca2+ at various stages of the coagu-lation cascade.

Blood coagulation reduction when in contact with the dialyzer, preventing from blocking, thus keeping the useful surface area.

Daugirdas JT: Handbook of Dialysis. Fourth Edition, 2001

MECHANISM OF ACTION

Blood

Dialysate

CITRIC ACID EFFECTS IN THE DIALYZER

CITRIC ACIDPhysiologicalDissolves easily, stable in solutionMetabolized to Bicarbonate at hepatic and muscular levelClotting preventionWidely used in medicine: as anticoagulant in blood bags and in UCI (regional anticoagulation*)

(*) N Engl J Med 308:258-61, 1983; Intensive Care Med 28:1419-25, 2002

HOW DOES IT ACT AS A DIALYZER?

Intrinsic Pathway

Intrinsic Pathway

XII

XI

IX

Ca2+

Ca2+

Ca2+

Ca2+

IXa

IXa VIIa VII

X

II IIa

I Ia

VIIa

Xa

V

X

XIIa

Dialysate Blood

Ca

CIT

Ca

CIT

CIT3- CIT3-

Ca2+ Ca2+

Dialysate Blood

CIT

Ca

CIT3-

Ca2+

There is a decrease of the plasma calcium levels during hemodialysis with CITRASATE®; those levels are recovered by the end of the session as the calcium citrate compounds metabolize to Ca2+ and citrate.

EFFECTS ON CALCIUM

EFFECTS ON COAGULATION: Heparin reduction

Kossmann RJ: 55% Heparin Reduction Using Citrate Dialysate. ASN’s 39th Annual Renal Week Meeting, San Diego, California, November 2006

There is a 55% reduction of heparin when using CITRASATE® in the dialysis bath after 3 months.

Heparin units

CITRASATE® CITRASATE®Standard HD

2 months

3 months

0

750

1500

2250

3000

3750

4500

5250

33%55%

CITRASATE®

EFFECTS ON INFLAMMATION

20

22

24

26

28

30

p<0,001

ß2 (mg/l)

CITRASATE®standard HD

28,1±10

25,9±10

Kossmann RJ: Increased efficiency of hemodialysis with citrate dialysate: a prospective controlled study. Clin J Am Soc Nephrol, 4:1459-64; 2009

Decreases the neutrophi-les activation.

Decreases inflammatory mediators.

Better biocompatibility.

When changing from the standard dialysis to the bath with CITRASATE® the ß2-microglobulin plasma levels decreases significantly.

J AM SOC NEPHROL 5:110-15; 1994 J AM SOC NEPHROL 5:110-15; 1994Nephrol Dial Transplant 12:1387-93; 1997

CITRIC ACID EFFECTS ON THE EFFICIENCY OF DIALYSIS (eKt/V)

1,45

1,47

1,49

1,51

1,53

1,55

1,57

1,59

1,61

p<0,001

p=ns

p<0,001

p<0,001n=69

n=73

CITRASATE®Standard HD

1,60±0,17

1,55±0,2

1,59±0,18

1,52±0,17

1,55±0,2

1,48±0,19

1,50

1,52

1,55

1,57

1,60

p<0,001

eKt/v

n=142


1,51±0,01

1,57±0,01


When passing from the standard bath to dialysis using CITRASATE® the eKt/V increases considerably.

When passing from dialysis bath with CITRASATE® to standard dialysis the eKt/V ( ) decreases substantially. The eKt/V is maintained if continue with CITRASATE® ( ).

Part of the citrate (CIT3-) and plasma calcium (Ca2+) are joined together forming the CIT-Ca complex, causing a decrease in the levels of ionized calcium necessary for the clotting cascade, with a decrease in blood coagulability at a local level.

The complex (CIT-Ca), the free citrate molecules (CIT3-), and the ionized calcium (Ca2+) pass easily through the dialyzer membrane until getting a transmembrane balance.

HOW DOES IT ACT AT A SYSTEMIC LEVEL?

HCO-3Ca2+

Calcium liberation: Citrate metabolized into bicarbonate (Krebs cycle):

Ca

CIT

CIT3-

Ca2+

Once in the blood, the citrate-calcium (CIT-Ca) complex rapidly recomposes into citrate (CIT3-) and calcium (Ca2+). The Ca2+ is now available in the total pool of circulating calcium and the citrate is metabolized into bicarbonate in the Krebs cycle, giving a better correction of the acidosis in the interdialytic period.

Ahmad S, et al: Dialysate made from dry chemicals using citric acid increases dialysis dose. Am J Kidney Dis; Vol. 35, No 3, March 2000: pp 493-499

Beginning 1 hour 2 hours 3 hours End End + 1h

Ionized Ca 1.27±0.07 1.26±0.07 1.28±0.06 1.27±0.11 1.27±0.10 1.24±0.12

Ionized Ca 1.28±0.09 1.14±0.12 1.12±0.08 1.09±0.12 1.12±0.11 1.16±0.10

Citrate 2.61±0.54 2.74±1.00 2.76±0.49 2.70±0.58 2.96±0.82 2.61±0.86

Standard Bath Dialysis

CITRASATE® Dialysis Bath

Blood coagulation when in contact with the dialyzer reduces its effective surface and reduces its efficiency.

Citric Acid forms complexes with the blood Ca2+ redu-cing the necessary Ca2+ at various stages of the coagu-lation cascade.

Blood coagulation reduction when in contact with the dialyzer, preventing from blocking, thus keeping the useful surface area.

Daugirdas JT: Handbook of Dialysis. Fourth Edition, 2001

MECHANISM OF ACTION

Blood

Dialysate

CITRIC ACID EFFECTS IN THE DIALYZER

CITRIC ACIDPhysiologicalDissolves easily, stable in solutionMetabolized to Bicarbonate at hepatic and muscular levelClotting preventionWidely used in medicine: as anticoagulant in blood bags and in UCI (regional anticoagulation*)

(*) N Engl J Med 308:258-61, 1983; Intensive Care Med 28:1419-25, 2002

HOW DOES IT ACT AS A DIALYZER?

Intrinsic Pathway

Intrinsic Pathway

XII

XI

IX

Ca2+

Ca2+

Ca2+

Ca2+

IXa

IXa VIIa VII

X

II IIa

I Ia

VIIa

Xa

V

X

XIIa

Dialysate Blood

Ca

CIT

Ca

CIT

CIT3- CIT3-

Ca2+ Ca2+

Dialysate Blood

CIT

Ca

CIT3-

Ca2+

There is a decrease of the plasma calcium levels during hemodialysis with CITRASATE®; those levels are recovered by the end of the session as the calcium citrate compounds metabolize to Ca2+ and citrate.

EFFECTS ON CALCIUM

EFFECTS ON COAGULATION: Heparin reduction

Kossmann RJ: 55% Heparin Reduction Using Citrate Dialysate. ASN’s 39th Annual Renal Week Meeting, San Diego, California, November 2006

There is a 55% reduction of heparin when using CITRASATE® in the dialysis bath after 3 months.

Heparin units


2 months

3 months


2 months

3 months

0

750

1500

2250

3000

3750

4500

5250

33%55%

CITRASATE®

EFFECTS ON INFLAMMATION

20

22

24

26

28

30

p<0,001

ß2 (mg/l)

CITRASATE®standard HD

28,1±10

25,9±10


Decreases the neutrophi-les activation.

Decreases inflammatory mediators.

Better biocompatibility.

When changing from the standard dialysis to the bath with CITRASATE® the ß2-microglobulin plasma levels decreases significantly.

J AM SOC NEPHROL 5:110-15; 1994 J AM SOC NEPHROL 5:110-15; 1994Nephrol Dial Transplant 12:1387-93; 1997

CITRIC ACID EFFECTS ON THE EFFICIENCY OF DIALYSIS (eKt/V)

1,45

1,47

1,49

1,51

1,53

1,55

1,57

1,59

1,61

p<0,001

p=ns

p<0,001

p<0,001n=69

n=73


1,60±0,17

1,55±0,2

1,59±0,18

1,52±0,17

1,55±0,2

1,48±0,19

1,50

1,52

1,55

1,57

1,60

p<0,001

eKt/v

n=142


1,51±0,01

1,57±0,01


When passing from the standard bath to dialysis using CITRASATE® the eKt/V increases considerably.

When passing from dialysis bath with CITRASATE® to standard dialysis the eKt/V ( ) decreases substantially. The eKt/V is maintained if continue with CITRASATE® ( ).

Part of the citrate (CIT3-) and plasma calcium (Ca2+) are joined together forming the CIT-Ca complex, causing a decrease in the levels of ionized calcium necessary for the clotting cascade, with a decrease in blood coagulability at a local level.

The complex (CIT-Ca), the free citrate molecules (CIT3-), and the ionized calcium (Ca2+) pass easily through the dialyzer membrane until getting a transmembrane balance.

HOW DOES IT ACT AT A SYSTEMIC LEVEL?

HCO-3Ca2+

Calcium liberation: Citrate metabolized into bicarbonate (Krebs cycle):

Ca

CIT

CIT3-

Ca2+

Once in the blood, the citrate-calcium (CIT-Ca) complex rapidly recomposes into citrate (CIT3-) and calcium (Ca2+). The Ca2+ is now available in the total pool of circulating calcium and the citrate is metabolized into bicarbonate in the Krebs cycle, giving a better correction of the acidosis in the interdialytic period.

Ahmad S, et al: Dialysate made from dry chemicals using citric acid increases dialysis dose. Am J Kidney Dis; Vol. 35, No 3, March 2000: pp 493-499

Beginning 1 hour 2 hours 3 hours End End + 1h

Ionized Ca 1.27±0.07 1.26±0.07 1.28±0.06 1.27±0.11 1.27±0.10 1.24±0.12

Ionized Ca 1.28±0.09 1.14±0.12 1.12±0.08 1.09±0.12 1.12±0.11 1.16±0.10

Citrate 2.61±0.54 2.74±1.00 2.76±0.49 2.70±0.58 2.96±0.82 2.61±0.86

Standard Bath Dialysis

CITRASATE® Dialysis Bath

Hypotension

Intolerance

• Elderly patients.• 21.5% diabetes mellitus (first cause of CKD in patients between 45 and 75 years old).• First therapeutic option: Hemodialysis (85.1%).

2009 Spanish Registry for Kidney Diseases. www.senefro.org

Hemodialysis Treatment for Acute and Chronic Renal Failure

• Vascular resistance incorrect adjustment: vasodilatation

• Myocardial Depression• Arrhythmia

Pol. Ind. TUMSA - Nave nº 31 · E-25230 Mollerussa · Lleidawww.niprorenalsolutions.com

CITRASATE® is a trademark of Advanced Renal Technologies

Rev: 07/2013

ACID CONCENTRATE FOR HEMODIALYSISMINIMUM ACETATE CONCENTRATION

CITRASATE®CITRASATE®

COMPATIBLE WITH ALL TYPES OF MACHINESIMPROVES HEMODYNAMIC TOLERANCE

LOWER INFLAMATORY RESPONSEINCREASES DIALYSIS EFFICIENCYIMPROVES ACIDOSIS ADJUSTMENT

CLOTTING PREVENTION

MAIN ADVANTAGES

ACETATE EFFECTS ON THE DIALYSIS BATH

CURRENT POPULATION

CURRENT OPTIONS FOR HEMODIALYSIS

CITRASATE®

• Biofiltration• Hemodialysis without acetate: • AFB • Online PHF • With HCl• Online Hemodiafiltration

Disadvantages:• They require special machines increasing

treatment cost• They cannot be used with all population

CITRASATE® is an acid concentrate for hemodialysis with a minimum concentration of acetate substituting acetic acid for citric acid.

SUITABLE FOR:

Elderly PatientsDiabetic Patients

Patients with a Cardiovascular PathologyCritical Patients or Bleeding Risk in Patients

Patients with Heparin Antibodies

Incorrect Dialysis: dosagePrescribed Dialysis ≠ dosageAdministered Dialysis

ACETATE

ONLY

mEq/l

0,3Conventional Hemodialysis MachineImproved Hemodynamic ToleranceLower Inflammatory ResponseDialysis Higher EfficiencyImproved Correction of Acidosis Lower Heparin Dosage

RENAL SOLUTIONS

catálogo citrasate rev 07-2013 eng - nipro renal solutions · there is a 55% reduction of heparin...

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