REFERENCES & FORMULAS

Morabito S, Pistolesi V, Tritapepe L, Fiaccadori E. Regional citrate  anticoagulation for RRTs in critically ill patients with AKI. Clin J Am  Soc Nephrol. 2014 Dec 5;9(12):2173-88. 

PMC4255392.

Kindgen-Milles D, Brandenburger T, Dimski T. Regional citrate  anticoagulation for continuous renal replacement therapy. Curr Opin Crit  Care. 2018 Dec;24(6):450-454. 

PMID:  30247214.

Zarbock A, et al. Effect of Regional Citrate  Anticoagulation vs Systemic Heparin Anticoagulation During Continuous  Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality  Among Critically Ill Patients With Acute Kidney Injury: A Randomized  Clinical Trial. JAMA. 2020 Oct 27;324(16):1629-1639.

PMC7585036

Citrate  infusion rate  =  (treated blood per hour x citrate dose (mmol/L ) / citrate concentration (mmol/L)

Treated blood per hour = blood flow (ml/min) x 60  

Citrate load and removal calculations assume that citrate has a  sieving coefficient of 1  and therefore effluent saturates near to 100%  

Citrate load to circuit = (treated blood per hour / 1000 ) x  citrate dose (mmol/L) 

Citrate mass removal = [((effluent volume (L) ) x citrate dose (mmol/L))/ citrate load to circuit  (mmol/hr)] x 100

Citrate load to patient =  citrate load to circuit (mmol/hr) -  (effluent volume (L)  x citrate dose (mmol/L))

The elemental calcium  infusion calculator is based on  the theoretical  calcium removal with  CRRT effluent  and  therefore the recommended calcium replacement infusion.  The limit for calcium removal by CRRT has been established in 6 mmol/hr

This is a simplified  version of the  second phase mathematical model proposed by  Zheng et al  and Yu  et al.  This simplified model has been validated in a prospective  cohort pending publication.

Zheng Y, Xu Z, Fan Q, Zhu Q, Ma S, Lu J, Zhuang F, Hao G, Lu W, Ding F.  Calcium supplementation in CVVH using regional citrate anticoagulation.  Hemodial Int. 2019 Jan;23(1):33-41. 

 PMID: 30716204.         

Yu W, Zhuang F, Ma S, Fan Q, Zhu M, Ding F. Optimized Calcium  Supplementation Approach for Regional Citrate Anticoagulation. Nephron.  2019;141(2):119-127. 

PMID:  30448847.

 Calcium preparation asumes that calcium vials are: 

Calcium Chloride 10%, 10 ml vials = 1 gram, 13.6 meq, 6.8 mmol of elemental calcium

Calcium Gluconate 10%, 10 ml vials = 1 gram, 4.65 meq, 2.32 mmol of elemental calcium