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 a sieving coefficient of 0.95–1, and therefore an effluent saturation close to 100%. Although citrate load depends on plasma flow rather than blood flow, this calculator uses blood flow to simplify the input load.

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, and of the linear correlation between citrate load and calcium removal reported by Mariano et al,  and It accounts for a fixed hematocrit of 35%. This simplified model has been validated in a prospective cohort study 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.

Mariano F, Morselli M, Bergamo D, Hollo Z, Scella S, Maio M, Tetta C, Dellavalle A, Stella M, Triolo G. Blood and ultrafiltrate dosage of citrate as a useful and routine tool during continuous venovenous haemodiafiltration in septic shock patients. Nephrol Dial Transplant. 2011 Dec;26(12):3882-8.

PMID: 21385861.

 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