Kidney Week

Abstract: TH-PO0729

Calcium Control and Electrolyte Stability During Regional Citrate Anticoagulation Using a Fully Integrated CRRT System: Insights from a Prospective Multicenter Study

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Yessayan, Lenar Tatios, University of Michigan Medical School, Ann Arbor, Michigan, United States

Lenar Tatios Yessayan, MD, MS

• Vijayan, Anitha, Intermountain Medical Center, Murray, Utah, United States

Anitha Vijayan, MD, FASN

• Matzumura Umemoto, Gonzalo, Washington University in St Louis School of Medicine, St. Louis, Missouri, United States

Gonzalo Matzumura Umemoto, MD

• Karakala, Nithin, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

Nithin Karakala, MD, FASN

• Ayub, Fatima, Central Arkansas Veterans Healthcare System John L McClellan Memorial Veterans Hospital, Little Rock, Arkansas, United States

Fatima Ayub, MD, FASN

• Trainor, Matthew J., University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States

Matthew J. Trainor, MD

• Wells, Catherine C., University of Mississippi Medical Center, Jackson, Mississippi, United States

Catherine C. Wells, CNN-NP, DNP

• Uduman, Junior, Henry Ford Hospital, Division of Nephrology and Hypertension, Detroit, Michigan, United States

Junior Uduman, MD, FASN

• Lopez-Ruiz, Arnaldo F., AdventHealth Orlando, Orlando, Florida, United States

Arnaldo F. Lopez-Ruiz, MD

• Dillon, John J., Mayo Clinic Minnesota, Rochester, Minnesota, United States

John J. Dillon, MD, MS, FASN

• Juncos, Luis A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Luis A. Juncos, MD, FASN

• Thompson, David, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

David Thompson, DO

• Szamosfalvi, Balazs, University of Michigan Hospital, Ann Arbor, Michigan, United States

Balazs Szamosfalvi, MD, FASN

Group or Team Name

• SARCA Study Group

Background

Calcium management during CRRT is required to ensure effective RCA while maintaining systemic electrolyte stability. Protocols such as the Berlin protocol emphasize tight control of post-filter ionized calcium (iCa) levels. However, implementation remains complex and may lead to electrolyte disturbances.

Methods

In this prospective, open-label, multicenter study, adult patients requiring CRRT were treated using the multiFiltratePRO system with integrated Ci-Ca module to facilitate RCA delivery. 31 patients were enrolled across 10 US sites. Patients received CVVHD or post-filter CVVHDF per clinician's discretion. Post-filter iCa levels were assessed and adjusted as needed 5-10min after treatment start, every 6-8hours during treatment period, and 5-10mins after Ci-Ca treatment is turned-off. Safety endpoints including AEs related to study drug were documented throughout the complete treatment period.

Results

Average post-filter iCa levels remained within the expected RCA target range across 76% of treatment days, with an overall mean of 0.31mmol/L, indicating stable anticoagulation control over time.
Treatment-related AEs were consistent with known effects of RCA and CRRT and included electrolyte disturbances such as hypocalcemia, hypercalcemia, and metabolic alkalosis. These events were infrequent and manageable, and no citrate-related toxicity was observed.
Overall system performance remained consistent across treatment duration and independent of prior site experience.

Conclusion

Integrated citrate-calcium automation, delivered via the MFT PRO system, maintained post-filter iCa within RCA targets with infrequent, manageable electrolyte disturbances and no citrate toxicity, supporting its safety and feasibility in routine clinical practice.

Acknowledgment

We thank all participating study sites (University of Michigan Hospital, Central Arkansas VA Healthcare System, University of Arkansas for Medical Sciences, Washington University School of Medicine, University of Massachusetts, Mayo Clinic, University of Mississippi Medical Center, Intermountain Medical Center, Henry Ford Hospital, AdventHealth) and their investigators, coordinators, nurses, and participants for their valuable contributions to this study.

Funding

• Commercial Support – This study was sponsored by Fresenius Medical Care.