Dry

itrasate

COst effective

active high dose of dialysis

more effective treatments

With less or no heparine

easily implimented

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global meditronic
Tel.: +91 44 42109535 / +91 9551655114
email: info@globalmeditronic.in
www.globalmeditronic.in
 Product Overview

Advanced Renal Technologies provides an advanced dialysis Dry Citrasate

(dialysate) formulation containing citric acid - the first major change in
dialysate chemical composition in 30years.

Dry Citrasate

Dry Citrasate is a dry powdered version that can be mixed by the user to
make A concentrate. The use of citric acid in the dialysate has been
shown to be a safe and effective way to provide better dialysis therapy.

ADVANCED FORMULATION

Dialysate Concentration ` Chemical Composition

(Not incuding Component B)
Diluted 1.35.83 Sodium Chloride (I.P.) 172.19 (gms/L)
Sodium 80.3 (MEq/L) Potassium Chloride (I.P.) 5.49 (gms/L)
Potassium 2.0 (MEq/L) Calcium Chloride (I.P.) 8.12 (gms/L)
Calcium 3.0 (MEq/L) Magnesium Chloride (I.P.) 3.74 (gms/L)
Magnesium 1.0 (MEq/L) Sodium Acetate (I.P.) 1.50 (gms/L)
Chloride 86.0 (MEq/L) Citric Acid (I.P.) 5.66(gms/L)
Acetate 0.3 (MEq/L)
Citrate 2.4 (MEq/L)

Citrate dialysate is safe and effective in all dialysis patients, but it has been
particularly effective because it improves dialyzer reuse

Product Benefits

Citrate dialysis has been shown to provide improved treatment for patients on routine
long-term hemodialysis when compared to currently used dialysate formulations. Patients
who appear to particularly benefit from citrate dialysate are those with dialyzer clotting or
increased risk of bleeding problems. Patients in these two categories include:

1. those whose dialyzers clot despite large amounts of heparin

2. those who cannot use heparin, e.g., those with heparin antibodies
3. patients actively bleeding or who are at risk of hemorrhage.

Patient Benefits
• Eliminates or Reduces Heparin need in RF patients
• Reduces post - dialysis Bleeding
• Increase dialysis dose Kt/V
• Improves correction of Acidosis
• Lowers dialysis related Inflammation
 ???????????????????
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» Is Citrasate® cleared for clinical use by the FDA? ???????????????????
Yes.
???????????????????
» How do I adapt my present dialysis system to allow the use of Citrasate® ???????????????????
No adaptations are necessary. Dry Citrasate® concentrate is available in standard
???????????????????
the pack and pour it into your standard A concentrate container and attach it to ???????????????????
plastic bags. Simply mix it with purified RO water as per the instructions given on

your dialysis machine as you always do. ???????????????????

» What steps are necessary before dialysis with Citrasate® can be started? ???????????????????
Citrasate® may be used in existing dialysis systems without altering them. There is ???????????????????
no additional patient or system monitoring needed beyond that normally employed in treatment with standard dialysate
formulations. Consequently, no staff training is necessary for the conversion to citrate dialysate.

» Can Citrasate® be "spiked" with potassium or calcium?

Yes, it can be spiked just as you do with traditional dialysate concentrates

» Is it necessary to check clotting times when Citrasate® is used?

No.

» Is there reason to be concerned about bleeding risk, hypocalcemia, or hypomagnesemia when treating
patients with Citrasate®?
No. There is no risk of bleeding or low blood mineral levels from citrate use, because the concentration of citrate in the dialysate
is well below the level needed to produce anticoagulation of the patient's blood.

» Can dialysate flow affect Citrasate's anticoagulation benefit?

With a higher dialysate flow rate - more citrate, in relation to the blood passes through the dialyzer, thus providing more antico-
agulation. With SLEDD treatments, longer clot free runs have been achieved.

» How is Citrasate supplied?

Dry Citrasate® is a powder concentrate, available in plastic bags of two different sizes 10litre Mix and 50litre Mix

» How does citrate dialysate provide the noted patient benefits?

Citric acid is an anticoagulant. Its presence in the dialysate 2.4 mEq/L, concentration provides some anticoagulation effect in
the dialyzer and venous blood line that is quickly neutralized upon re-entry into the systemic circulation.

» Is Citrasate® the same as regional citrate anticoagulation?

No. Performing dialysis with Citrasate® is no different operationally than doing regular dialysis. There is no regional infusion of
citric acid employed. "It's all in the dialysate."

» Do we need to be concerned with hypocalcemia?

No. The concentration of citrate in Citrasate is only 2.4mEq/L; about one-fifth of the concentration used to achieve
anticoagulation via traditional regional citrate infusions. The use of Citrasate does not produce measurable systemic
anticoagulation; the anticoagulant effect is confined to the dialyzer and the venous side of the dialysis set-up. Citrasate
generally produces a clinically acceptable transitory reduction (about 10%) in ionized calcium. Ionized calcium begins to
normalize to the pre-dialysis level as soon as the Citrasate dialysis session stops. The consistent treatment of chronic dialysis
patients with Citrasate has demonstrated no change over extended time periods in either total or ionized serum calcium levels.
 AMERICAN JOURNAL OF KIDNEY DISEASES

“Dialysate made from dry chemicals using citric acid

increases dialysis doses”

"We changed to ART's citrate dialysate

“Fifty Five Percent Heparin Reduction is to treat a chronic ESRD patient who
Safe with Citrate Dialysate in Chronic Dialysis
had heparin antibodies. Previously,
Patients” .. Robert J Kossmann, MD.
Nephrophiles LLC, Santa Fe, New Mexico
when using regular dialysate
without heparin, the patient
“Heparin Free Slow Low Effective Dialysis typically required one or two
(SLED) Using Citrate Dialysate (CD) Is Safe and dialyzers per treatment due to
Effective” S.Ahmad, San Diego, Calif. clotting. With citrate dialysate,
we not only completed
"Citrasate concentrate is a very cost-effective
treatments without clotting, the
answer to providing better dialysis to patients with
patient is now averaging three
bleeding or clotting problems.".. Dr. Suhail
Nephrologist and Medical Director reuses from one dialyzer."
Scribner Kidney Center, Seattle, WA
... Larry Hart
Certified Hemodialysis Technician, Director of
Technical Services Renal Care Center,
San Luis Obispo, CA

We have been using Citrasate Dialysate since 4year in Manipal

Hospital, Bangalore and in our peripheral centres, The citrasate has

reduced the consumption of heparin by 30% in our patients and

it also enhances the dialyzer reuse and dialysis dose.

Abul Kasim, Sr. Manager – Dialysis

Manipal Hospital, Bangalore - 560017

For More Information Call:

+91 9551655114