Table 1.

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

Weight	Effluent Flow, QEFF ml/h	Blood Flow, QB ml/min	Citrate Flow, ACDA ml/h	Dialysate Flow, QD ml/h	Postdilution Flow, QRF ml/h
≤50 kg	1900+	50	125	1250	500
51–60 kga	2300+	60	150	1500	600
61–70 kg	2650+	70	175	1750	700
71–80 kg	3050+	80	200	2000	800
81–90 kg	3450+	90	225	2250	900
91–100 kga	3800+	100	250	2500	1000
101–110 kg	4200+	110	275	2750	1100
111–120 kg	4550+	120	300	3000	1200
121–130 kg	4950+	130	300	3250	1300
131–140 kg	5300+	140	300	3500	1400
≥141 kga	5650+	150	300	3750	1500

Table 1 flow settings ensure >0.75 single-pass fractional removal of citrate (E_Cit) on the dialyzer limiting systemic citrate accumulation to ≤2.5 mM (C_Max) 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.

^aPatients included in this study were treated using one of these rows.