Acute Therapy Systems

multiFiltratePRO
Supporting your clinical practice

Ci-Ca® multiIntenseCare
 multiFiltratePRO

Clear focus on key needs in the ICU

In discussions with CRRT users we often hear about • Treatment safety based on long-standing
increasing workload compression in the intensive experience
care unit (ICU) and we hear about their demand for Ci-Ca® as regional citrate anticoagulation
error-free and efficient use of resources. With the contributes to overall treatment safety by mini-
multiFiltratePRO Fresenius Medical Care aims to mizing bleeding risk. 1–3 A multitude of sensors
fulfil these requirements in the best way possible: continuously monitors the therapy. When the
multiFiltratePRO cannot correct a situation itself,
alarms display probable reasons to ease identifi-
cation of the root cause.

• Focus on truly continuous CRRT and

haemodynamic stability
Gentle fluid removal and thus haemodynamic
stability is aimed at by means of truly continu-
ous CRRT through citrate anticoagulation. 4
Economically this also means longer filter ­
patency and thus less consumption of filters
and less workload for nurses.

• Comprehensively integrated Ci-Ca®

anticoagulation
Intelligent therapy support via the screen
is enabled by integrating all pumps in the
­multiFiltratePRO. So any ICU may use this
anticoagulation method with its proven clear
reduction of bleeding complications for the
vast majority of their patients. 1–5

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 multiFiltratePRO

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Focus on simple and effective therapy
application

• Large screen enables display of comprehensive

information, e.g. therapy information or potential
reasons in case of alarms

• The touch screen monitor has enhanced read-

ability from various angles

• Intuitive step-by-step instructions for relevant

­handling situations

• To ease handling in the ICU, fluid heaters are

fully integrated into the device

• Regional Ci-Ca® citrate anticoagulation to

­minimise the risk of bleeding complications 1–3

• Long effective treatment times allow for efficient

fluid removal via low hourly fluid removal rates; this
supports haemodynamic stability 4

•  Ci-Ca® avoids downtime, thus the delivered

CRRT-dose is in accordance with the prescription 4

• “Care-Mode” to prevent unnecessary alarms

and to save time: temporarily ­decreased blood
flow, stopped balancing system and extended
pressure limits during patient care

• High capacity scales reduce the number of bag

changes and thus user interactions

• 4-wheel chassis with 2-stage locking system

­allows turning on the spot

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 multiFiltratePRO

Long-standing experience with Ci-Ca® anticoagulation

Healthcare personnel in more than 30 countries have gained experience and benefited from Ci-Ca® citrate
anticoagulation during more than 500,000 treatment runs.

• Ci-Ca® Dialysate compositions well-concerted • With Ci-Ca® CVVHD the released filter lifetime
with the established 4% sodium citrate solution2, 6 of 72 hours is reached in most cases; making
filter changes a projectable activity 2, 4, 7
• Long-term proven Ci-Ca® protocol, building on
experience since 2004 2–10 • Three Ci-Ca® therapy options: Ci-Ca CVVHD,
­Ci-Ca® postCVVHDF and Ci-Ca® EMiC®2
• Ci-Ca® module as integral part of
multiFiltratePRO • Ci-Ca® EMiC®2 uses an optimised haemofilter
enabling diffusive middle molecule clearance
• All involved pumps controlled via a single partly exceeding the level achieved with CVVH 11
user interface

Statement on the Ci-Ca® protocol:

“[It] enabled an effective treatment of acute renal failure

and excellent control on the acid–base status as well on

the systemic ionised calcium in combination with negligible

clotting issues.” 2

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 The integrated Ci-Ca® anticoagulation with the
multiFiltratePRO carries forward intelligent links
Ci-Ca® Dialysate K2 / K4
Ci-Ca® Dialysate K2 / K4 P lus between the CRRT-pumps, for which the user does
not have to look up values manually in tables:
CaCl2 Solution

• Infused volumes of the citrate and calcium

solutions are automatically balanced with the
filtrate pump
Haemo-
filter
Patient
• If the blood flow is changed, the device
automatically adjusts the citrate pump

4% Na3
Citrate • If the filtrate flow is changed, the calcium pump is
Filtrate adjusted accordingly
Ci-Ca® CVVHD / Ci-Ca® EMiC®2:
Extracorporeal circuit with citrate anticoagulation In addition, the multiFiltratePRO supports the user
with expert information:

• For routine adjustments of the Ci-Ca® therapy,

information from the protocol can easily be
retrieved on the screen (see fig. left)

• In case of certain values set outside the standard

range, the multiFiltratePRO makes the user aware
of potentially risky clinical situations

Further advantages of the multiFiltratePRO

with Ci-Ca®:

• During bag changes (dialysate, substituate,

filtrate) the citrate infusion continues for a
Screen during Ci-Ca® CVVHD application
provides key info from the Ci-Ca® protocol reliable period of time. This helps to avoid early
coagulation of the system

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 multiFiltratePRO

Practical and economic advantages

Due to reduced healthcare budgets, cost pressure • Up to 20 L fresh CRRT-fluid can be connected
is increasing. From this perspective the cost factors at a time resulting in long time intervals between
for the device (incl. service and repairs), disposables bag changes
(filters, solutions) and staff (nurses, physicians) are
decisive. • Lack of significant predilution results in efficient
use of the CRRT-fluids. Approx. 30% more
replacement fluid can be required in predilution
compared with to postdilution 12
The practical and economic advantages of the
Ci-Ca® therapy can be summarized as follows: • Taking all this together, minimised workload for
the staff allows an efficient patient-nurse relation
• Long filter patency, predominantly reaching 72 h,
reduces the number of kits required 2, 4, 7

• Process optimization enabled: filter changes

are possible at convenient times, e.g. on Friday
afternoon for low workload during the weekend
(see fig. below)

Citrate

Heparin

Tu We Th Fr Sa Su Mo Tu We

Premature clotting causing mistimed filter change or treatment interruption,

Planned filter changes
e.g., on weekends or during the night

Schematic depiction of filter changes during CRRT treatment: heparin vs Ci-Ca® citrate anticoagulation

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Reliable technology, reliable service

Clinical service Technical service

Striving to be your professional partner, we offer a The multiFiltratePRO is as easy to maintain as it is
wide range of clinical support by our professional to use. The system is backed by tried-and-tested
sales teams and experienced application special- technologies and experienced people with expertise
ists, both backed up by contacts with experienced gained in clinical reality.
­physicians.
Diagnostic programs specific to the device as well as
CRRT expert meetings, workshops for physicians our well-trained technicians are a basis for excellent
and regular education courses for nurses teach the device availability. This translates into cost savings
know­ledge to apply efficient CRRT. and allows you to focus on your daily work.

Fresenius Medical Care supports you from the initial Logistical service
implementation of your CRRT program to the point In case of order transactions or logistical manage-
of daily questions. If you need any help setting up a ment, the customer support is there to assist you.
treatment on the multiFiltratePRO, face a question
during an ongoing CRRT treatment or have any
questions in general, just call your local support hot-
line or Fresenius Medical Care representative.

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 multiFiltratePRO

multiIntenseCare

Fresenius Medical Care

With several decades of experience in dialysis and the continuous improvement of our therapy options, Fresenius
Medical Care is the global leader in dialysis services and products. The highest medical standards are our
benchmark.
multiIntenseCare by Fresenius Medical Care is a comprehensive concept for the supply of your ICU patients.
It is our goal to constantly improve the work of physicians and hospital staff in order to save lives.

Ci-Ca® multiIntenseCare

Ci-Ca®
Fresenius Medical Care was the first to offer a The therapy circle symbolizes the complete
complete Ci-Ca® regional citrate anticoagulation. therapy range, combining products, therapy assis-
Ci-Ca® improves anticoagulation in CRRT and tance, training and education, and service support.
reduces the risk of bleeding complications.1–3

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 Ci-Ca® multiIntenseCare

multiFiltratePRO

The Pillars

Products & Therapy Training & Service

Disposables Assistance Education Support

Products & Therapy Assistance Training & Education Service Support

Disposables Bearing the clinical Besides direct training Intensive care units work
Our product design application in mind, on products and their 24/7 and CRRT can be
follows a holistic ap- Fresenius Medical Care application, Fresenius required at any time.
proach. CRRT monitors, goes beyond standard Medical Care participates Through accurate device
haemofilters, tubing service and assists staff in numerous events for maintenance and quick
systems and fluids by providing complemen- physicians and nurses repairs when needed,
are designed for a tary therapy information. each year. A number of multiFiltratePRO is kept
well-concerted clinical these events are certified available to serve its pur­-
application. by regional medical asso- pose: delivering CRRT
ciations, some of them upon demand.
qualifying for Continuing
Medical Education
credits (CME).
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1. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int
Suppl 2012. 2:1-138
2. Morgera S et al., A safe citrate anticoagulation protocol with variable
treatment efficacy and excellent control of the acid-base status. Crit
Care Med 2009. 37:2018-24
3. Morgera S et al., Metabolic complications during regional citrate
anticoagulation in continuous venovenous hemodialysis: single-center
experience. Nephron Clin Pract 2004. 97:c131-6
4. Kalb R et al., Regional citrate anticoagulation for high volume
continuous venovenous hemodialysis in surgical patients with high
bleeding risk. Ther Apher Dial 2013. 17:202-12
5. Joannidis M, Regional citrate anticoagulation-finally on its way to
standardization? Crit Care Med 2009. 37:2128-9
6. Morgera S et al., Regional citrate anticoagulation in continuous
hemodialysis – acid-base and electrolyte balance at an increased
dose of dialysis. Nephron Clin Pract 2005. 101:c211-9
7. Link A et al., Total-to-ionised calcium ratio predicts mortality in
continuous renal replacement therapy with citrate anticoagulation in
critically ill patients. Crit Care 2012. 16:R97
8. Schultheiss C et al., Continuous venovenous hemodialysis with
regional citrate anticoagulation in patients with liver failure: a
prospective observational study. Crit Care 2012. 16:R162
9. Raimundo M et al., Maintaining normal levels of ionised calcium
during citrate-based renal replacement therapy is associated with
stable parathyroid hormone levels. Nephron Clin Pract 2013.
124:124-31
10. Khadzhynov D et al., Incidence and outcome of metabolic disarrange-
ments consistent with citrate accumulation in critically ill patients
undergoing continuous venovenous hemodialysis with regional citrate

zer tifizier t, PEFC / 04-31- 0 973

anticoagulation. J Crit Care 2014. 29:265-71
11. Rimmelé T et al., Super high-flux continuous hemodialysis: an efficient
compromise for blood purification in sepsis. Crit Care 2012.
16 (Suppl 1):S135
12. Huang Z et al., Operational characteristics of continuous renal
replacement modalities used for critically ill patients with acute kidney
injury. Int J Artif Organs 2008. 31:525-34

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Fresenius Group in selected countries. F00006541 MT-EN (0,5 MRM-pppp 01.15)

Head office: Fresenius Medical Care Deutschland GmbH · 61346 Bad Homburg v. d. H. · Germany
Phone: +49 (0) 6172-609-0 · Fax: +49 (0) 6172-609-2191
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