Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice

Table 2 Globally estimated total energy delivery for three common CRRT settings, postdilution CVVH and CVVHD using different citrate solutions with or without lactate replacement fluids, and predilution CVVH at a CRRT dose of 2 L/h

		TSC solution		ACD solution		Balanced solution
		CVVH post-dilution	CVVHD	CVVH post-dilution	CVVHD	CVVH pre-dilution
CRRT settings
QB	ml/minute	150	100	150	100	150
Citrate target	mmol/L QB	4	4	4	4	3.7
Citrate dose	mmol/h	36	24	36	24	33
CRRT dose	ml/h	2,000	2,000	2,000	2,000	2,500^a
Removal	Fraction	0.22	0.33	0.22	0.33	0
Delivery to the patient
Citrate	mmol/h	28	16	28	16.08	13
	kcal/h	14	8	14	8	7
	kJ/h	69	40	69	40	33
Glucose	mmol/h			34	20
	kcal/h			25	14
	kJ/h			105	61
Lactate	mmol/h	70	70	70	70
	kcal/h	23	23	23	23
	kJ/h	96	96	96	96
Total energy excluding lactate	kcal/24 h	343	196	946	543	163
	kJ/24 h	1,667	952	4,196	2,410	4,852
Total energy including lactate	kcal/24 h	897	750	1,501	1,098
	kJ/24 h	3,968	3,254	6,497	4,711

^aPredilution dose is corrected for loss due to dilution. Caloric equivalents per millimole: citrate 2.48 kJ (0.59 kcal), glucose 3.06 kJ (0.73 kcal) and lactate 1.37 kJ (0.33kcal). ACD, acid citrate dextrose; CRRT, continuous renal replacement therapy; CVVH, continuous venovenous hemofiltration; CVVHD continuous venovenous hemodialysis; QB, blood flow; TSC, trisodium citrate.

ISSN: 1364-8535