Table 1.

Prismaflex fixed flow settings for severe Shock patients are selected according to weight and/or total effluent flow goal

WeightEffluent Flow, QEFF ml/hBlood Flow, QB ml/minCitrate Flow, ACDA ml/hDialysate Flow, QD ml/hPostdilution Flow, QRF ml/h
≤50 kg1900+501251250500
51–60 kga2300+601501500600
61–70 kg2650+701751750700
71–80 kg3050+802002000800
81–90 kg3450+902252250900
91–100 kga3800+10025025001000
101–110 kg4200+11027527501100
111–120 kg4550+12030030001200
121–130 kg4950+13030032501300
131–140 kg5300+14030035001400
≥141 kga5650+15030037501500
  • Table 1 flow settings ensure >0.75 single-pass fractional removal of citrate (ECit) on the dialyzer limiting systemic citrate accumulation to ≤2.5 mM (CMax) even in the absence of citrate metabolism. Different rows yield a different hourly effluent flow; the prescriber may calculate the total effluent flow as a product of the dosing weight and desired ml/kg per hour dose, or may simply select the proper Table 1 row on the basis of dosing weight to deliver about 35–40 ml/kg per hour effluent dose. The fixed and high citrate-to-blood flow ratio is designed to achieve adequate citrate anticoagulation (circuit iCa <0.4 mM) irrespective of variable systemic hematocrit (Hct) level, and hence plasma flow rate at a fixed QB. Very high effluent flows relative to circuit plasma flow ensure >70% single pass citrate removal and CKRT dose 38–42 ml/kg per hour in severe shock. QEFF, effluent flow rate; QB, postdilution continuous venovenous hemodiafiltration (CVVHDF) mode with low blood flow; ACDA, acid citrate dextrose anticoagulant flow; QD, bicarbonate-buffered dialysate flow; QRF, postdilution replacement fluid flow; CKRT, continuous KRT; iCa, ionized Ca.

  • a Patients included in this study were treated using one of these rows.