Acute Therapy Systems

multiFiltratePRO
A Perfect Fit for Every Team
 Fresenius Medical Care

A Lifelong Commitment

Fresenius Medical Care is the world’s largest

Treatment safety benefits from long-standing experience
integrated manufacturer and provider of products,
• Ci-Ca® as regional citrate anticoagulation contributes to overall treatment safety
by substantially reducing bleeding risk 1-2
therapies and services for dialysis treatment.
• Acid-base status well maintained 3

Focus on truly continuous CRRT and haemodynamic stability

Our comprehensive therapy choice
supports healthcare professionals to select
the most suitable treatment for changing
needs of patients in their critical conditions.
• Longer filter patency with effective citrate anticoagulation1-2 means less consumption
of filters and less workload for nurses 2
• Reduced number of bag changes further contributing to less treatment interruptions
Fully integrated Ci-Ca® regional citrate anticoagulation
• Dedicated citrate and calcium pumps
• Intelligent software provides on-screen Ci-Ca® monitoring information

We strive for our products, treatments and

services to align with international medical
and professional standards. This is our
commitment to our patients, our
partners, our investors and
our employees.

1 2
 A Perfect Fit for Every Team

Setting the standard in CRRT

The multiFiltratePRO is a new generation CRRT device
building on the substantial experience with the
multiFiltrate and the successfully integrated Ci-Ca® Dedicated citrate and calcium pumps for
regional anticoagulation. Patients receiving CRRT with optimal citrate anticoagulation management.
regional citrate anticoagulation benefit from less bleeding,
long filter running times and lower blood product High scale capacity: The scales for
fresh fluid and filtrate can hold up to 20L
requirements 1,3-5
.
fluid each, resulting in long time intervals
between bag changes.
The multiFiltratePRO offers Ci-Ca® therapy modes
as well as all common standard CRRT options:

Ci-Ca® CVVHD AV1000S

Ci-Ca® CVVHD EMiC®2
Ci-Ca® postCVVHDF
CVVHD
Post-CVVHDF
Pre-CVVHDF
Post-CVVH
Large and adjustable touch Automated insertion and ejection of all
Pre-CVVH pump segments for an easy set-up.
screen with status recognition
Pre-post CVVH light on top, visible from a
distance.

Air-free pressure monitoring for reduced

risk of coagulation and extracorporeal blood
volume.

Two integrated fluid heaters keep the

patient warm even at high flows, with no
increase in extracorporeal blood volume.
Four rotatable wheels with 2-stage
locking system and ergonomic handles
3 to allow easy transportation within narrow 4
spaces.
 A Perfect Fit for Every Team

Long intervals between bag changes

Thanks to a high scale capacity, one bag change is sufficient for a typical 8-hour nursing shift.

Advanced graphic user interface

The multiFiltratePRO offers a graphic user interface that monitors and displays all relevant
set-up and treatment data. When the multiFiltratePRO cannot correct the situation itself,
probable reasons are displayed to assist in the identification of the possible root cause.

Hours

Change of filtrate bags Change of dialysate bags Change of citrate bags Change of calcium bags

Timetable of bag changes for Ci-Ca CVVHD therapy (standard settings, dialysate flow 2 L/h)
®

• Step-by-step instructions for an easy set-up

• Information on next user action to

optimize workflows in the ICU

• Care mode to prevent unnecessary alarms

when moving the patient or adjusting
the catheter

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 A Perfect Fit for Every Team Towards Truly Continuous CRRT
Thanks to Ci-Ca® Regional Citrate Anticoagulation

Integrated safety features Fresenius Medical Care was the first to offer a complete
Ci-Ca® regional citrate anticoagulation for application in
• Integrated fluid heaters: Keeping the patient continuously warm CRRT4, enabling citrate anticoagulation as suggested in the
Fully integrated heaters for the substituate and dialysate keep the patient warm even at high flows. current KDIGO clinical practice guidelines for acute kidney
injury1.
• Hygienic design: Separation of fresh and used fluids
Design with separation of fresh fluids at the top and used fluids at the bottom of the device provides hygienic operation.
Fully integrated Ci-Ca® regional citrate
• Electrical safety fulfils the highest standards: Reliable use with central venous catheters
With respect to electrical safety, the multiFiltratePRO satisfies the safety class CF*. The multiFiltratePRO is approved for
anticoagulation
Citrate pump
parallel use of defibrillators which may be required in the ICU. In recent years, healthcare personnel in more than 30
countries have experienced the advantages of Ci-Ca®
* IEC 60601-1:2005 — Except countries using electrical supply with a line voltage of 220 V/ 230 V/240 V provided at 60 Hz and 240 V provided at 50 Hz: BF
anticoagulation during more than 500,000 treatment runs, via
clinically balanced fluids, a long-term proven protocol (building
on experience since 20042-4,6-10) and dedicated citrate and
calcium pumps as an integrated part of the CRRT device.2,3,6-8,10
Treatment kits at your disposal:
All you need in one box
Clear allocation of functionality
Each treatment kit contains the tubing and dialyser/filter required for the respective treatment. Dedicated pumps for citrate and calcium keep the syringe
pump available for heparin application even if needed during Calcium pump

Product Art. No. Surface volume/description Ci-Ca therapy. Separate level detectors and drip counters
®

enable timely detection of empty bags, enabling a smooth

multiFiltratePRO – 1.4 m2 ®
AV600S with preassembled multiFiltratePRO continuation of the treatment.
F00000460
Kit HDF 600 HDF Cassette, 216 ml total blood volume

multiFiltratePRO – 1.8 m2 ®
AV1000S with preassembled multiFiltratePRO Intelligent software support with Ci-Ca®
F00000461
Kit HDF 1000 HDF Cassette, 246 ml total blood volume therapy
The integrated Ci-Ca® regional citrate anticoagulation carries
multiFiltratePRO – 1.8 m2 ®
EMiC®2 with preassembled multiFiltratePRO
F00000462 forward intelligent links between the CRRT pumps, for which
Ci-Ca® HD EMiC®2 Ci-Ca® HD Cassette, 245 ml total blood volume
user does not have to look up values manually in tables:

multiFiltratePRO – 1.8 m 2 ®
AV1000S with preassembled multiFiltratePRO • Infused volumes of citrate and calcium solutions are
F00000463
Ci-Ca HD 1000
®
Ci-Ca HD Cassette, 245 ml total blood volume
® automatically balanced with the filtrate pump.

• If the blood flow is changed, the device automatically

multiFiltratePRO – 1.8 m2 ®
AV1000S with preassembled multiFiltratePRO
F00005329 adjusts the citrate pump.
Ci-Ca® HDF 1000 Ci-Ca® HDF Cassette, 245 ml total blood volume
• If the filtrate flow is changed, the calcium pump is
adjusted accordingly.

• The citrate infusion continues for a reliable period of time

during bag changes (dialysate, substituate, filtrate). This
helps to avoid an early coagulation of the system.

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 Towards Truly Continuous CRRT
Thanks to Ci-Ca® Regional Citrate Anticoagulation

Ci-Ca® CVVHD

• High efficiency with low blood flows

• Low systemic citrate load
• Targeted influencing of the acid-base status
• Easy adjustment of treatment dose Calcium-free
Ci-Ca® dialysate K2/ K4
• For minimal citrate requirement
and Ci-Ca® dialysate
Ci-Ca® postCVVHDF
11
K2/ K4 P lus Calcium-free Reduced sodium concentration (133 mmol/L)
dialysis solutions specifically • Compensates sodium supply with 4% sodium citrate solution
• Combines diffusive and convective clearance12
• Postdilution infusion avoids dilution effect (compared with developed for Ci-Ca regional
®

Adapted bicarbonate concentration (20 mmol/L)

predilution) citrate anticoagulation
• Targeted influencing of the acid base balance
• Effectiveness of a postCVVHDF therapy without additional
citrate load (compared to Ci-Ca® CVVHD)
Slightly increased magnesium concentration
• Compensates for the removed complexed magnesium
Ci-Ca® CVVHD
using EMiC® 2 Flexible Potassium option to optimize treatment
adjustment
• Use of EMiC®2 can enhance middle molecule clearance13 • Potassium levels of 2 mmol/L (K2) or 4 mmol/L (K4)
are available
• Cut-off at ~ 40 kDa
• Substantially stable albumin levels13

Ci-Ca® dialysate K2/ K4 P lus

Clinically balanced solutions for Ci-Ca® therapy
In the case of Ci-Ca® anticoagulation, it is essential to use CRRT
fluids which are clinically balanced with each other to avoid side
effects. With multiple Ci-Ca® dialysate compositions and a 4% citrate
solution, we offer suitable solutions for your prescriptions when using
citrate anticoagulation.
4% Sodium Citrate
Solution with 136 mmol/L citrate in 1.5L bag
For phosphate management
With a physical phosphate concentration of 1.25 mmol/L phosphate, Ci-Ca®
Dialysate K2/ K4 P lus inherently contributes to stabilising serum phosphate
concentration in the physiological range providing the essential phosphate
management, thereby adding further convenience to the Ci-Ca® therapy.
multiBic®
Bicarbonate-buffered substitution solution
When time is of the essence, every convenience helps. For example,
the diagonal peel-seam in the multiBic® double chamber bag is built
for simple handling. The improved gas barrier helps to keep the
ready-to-use bicarbonate solution stable for up to 48 hours.

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 Towards Truly Continuous CRRT Reliable Technology, Reliable Service
Thanks to Ci-Ca® Regional Citrate Anticoagulation

Safe and easy bag change Clinical service

• Safe: Color-coded connectors for dialysate and substituate With several decades of experience in dialysis and the continuous improvement of our therapy options, Fresenius Medical
fluids guide the user to avoid mix-up of bags Care is the global leader in dialysis services and products.

• Easy: Reduced number of bag changes by using up to 2 Striving to be your professional partner, we offer a wide range of clinical support by our professional sales teams and
bags on each upper scale experienced application specialists, both backed up by contacts with experienced physicians.

• Continuous: Citrate infusion during regular dialysate, We support you from the initial implementation of your CRRT program to the point of daily questions. If you need any help
substituate or filtrate bag changes contributing to less clotting setting up a treatment on the multiFiltratePRO, face a question during an ongoing CRRT treatment or have any questions
and longer filter lifespan in general, just call your local support hotline or Fresenius Medical Care representative.

Ci-Ca® protocol included in the software Technical service

The multiFiltratePRO is as easy to maintain as it is to use. The system is backed by tried-and-tested technologies and
For routine adjustments of Ci-Ca® therapy, information from the
experienced people with expertise gained in clinical reality. Through accurate device maintenance, multiFiltratePRO is kept
Ci-Ca® protocol can easily be retrieved on the screen. When
available to serve its purpose: delivering CRRT upon demand.
setting certain values outside of the standard range, the
multiFiltratePRO makes the user aware of potentially risky
clinical situations.

Ci-Ca® avoids significant predilution: multiFiltratePRO

Efficient use of CRRT fluid Supporting your clinical practice
With predilution, 30% more replacement fluid may be required
compared to postdilution.14
Products & Therapy Training & Service
Disposables Assistance Education Support

Change of treatment kits

become projectable Citrate
With Ci-Ca CVVHD the released filter
®

lifetime of 72 hours is reached in most

cases, making filter changes a Heparin

projectable activity.2,3,15
Tu We Th Fr Sa Su Mo Tu We

Premature clotting causing mistimed filter change or treatment

Planned filter changes
interruption, 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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 Technical Data References

1 KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012. 2:1-138
Dimensions and weight Heating
2 Kalb R et al., Regional citrate anticoagulation for high volume continuous venovenous hemodialysis in surgical patients with high bleeding risk. Ther
Height 167 cm Substituate temperature Off/ 35 - 39°C Apher Dial 2013. 17:202-12
Width 65 cm Dialysate temperature Off/ 35 - 39°C 3 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
Depth 69 cm Equipment function
4 Morgera S et al., Metabolic complications during regional citrate anticoagulation in continuous venovenous hemodialysis: single-center experience.
Weight approx. 95 kg Screen 15", TFT LCD Nephron Clin Pract 2004. 97:c131-6
Electrical supply Event storage stores up to 3,500 events 5 Monchi M et al., Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med
2004. 30:260-5
Voltage 100–240 V AC Service menu Settings via the screen
50–60 Hz 6 Khadzhynov D et al., Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing
Access pressure continuous venovenous hemodialysis with regional citrate anticoagulation. J Crit Care 2014. 29:265-71
Current consumption max. 4.4 A (240 V AC)
Display range –300 to +300 mmHg 7 Raimundo M et al., Maintaining normal levels of ionised calcium during citrate-based renal replacement therapy is associated with stable parathyroid
max. 12 A (100 V AC) hormone levels. Nephron Clin Pract 2013. 124:124-31
Accuracy ±10 mmHg
Lead acid battery 2 x 12 V/7.2 Ah, 8 Schultheiss C et al., Continuous venovenous hemodialysis with regional citrate anticoagulation in patients with liver failure: a prospective observational
maintenance-free Return pressure study. Crit Care 2012. 16:R162
Display range –100 to +500 mmHg 9 Joannidis M, Regional citrate anticoagulation-finally on its way to standardization? Crit Care Med 2009. 37:2128-9
Emergency operation duration min. 15 min
(Only blood pump) Accuracy ±10 mmHg 10 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
Electrical safety Transmembrane pressure
11 Huguet M et al., Clinical impact of regional citrate anticoagulation in continuous renal replacement therapy in critically ill patients. Int J Artif Organs 2017.
Type of protection against Protection class I Display range –300 to +520 mmHg 40:676-682
electrical shock Accuracy ±12 mmHg 12 Clark WR et al., Continuous Renal Replacement Therapies. Contrib Nephrol 2004. 144:264-277

Level of protection against Type CF (200–230 V, 50 Hz)
electrical shock (100– 127 V, 50 Hz)
(100– 127 V, 60 Hz)
Type BF (240 V, 50 Hz)
(200–240 V, 60 Hz)
Flow rates (depending upon treatment procedures)
Blood flow 10–500 mL/min, ±10%
Substituate flow 10–80 mL/min
13 Rimmelé T et al., Super high-flux continuous hemodialysis: an efficient compromise for blood purification in sepsis. Crit Care 2012.16 (Suppl 1):S135
Pre-filter pressure
14 Huang Z et al., Operational characteristics of continuous renal replacement modalities used for critically ill patients with acute kidney injury. Int J Artif
Measurement range –50 to +750 mmHg Organs 2008. 31:525-34
Accuracy ±10 mmHg 15 Slowinski T et al., Safety and efficacy of regional citrate anticoagulation in continuous venovenous hemodialysis in the presence of liver failure: the Liver
Citrate Anticoagulation Threshold (L-CAT) observational study. Crit Care 2015. 19:349
Air detector
Measurement procedure Ultrasound transmission
Sensitivity Air bubbles, blood foam
The names marked with ® are registered trademarks of Fresenius Medical Care in select countries.
or microbubbles

Dialysate flow 10–80 mL/min Optical detector Disclaimer:

Filtrate flow 0–180 mL/min Measurement procedure Infrared transmission All contents of this brochure are for informational purposes only and provided by Fresenius Medical Care Asia-Pacific Limited without warranties of any
kind. Healthcare professionals are solely responsible for making their own independent evaluation as to the efficacy or suitability of any product for any
Net. ultrafiltration rate 0–990 mL/h Function Detection of blood – no blood particular purpose. The availability of products mentioned in this brochure is subject to the regulatory requirements and product registration status in each
(net. weight loss) Increments 10 mL/h country. Products and technical specifications may change without notice. Please contact one of the representatives of Fresenius Medical Care in your
Blood leak detector
country for more details.
Citrate flow (Ci) 10–600 mL/h Measurement procedure optical
Citrate dose 2.0–6.0 mmol/L blood Sensitivity ≤ 0.5 mL/min blood loss
(citrate/blood) Increments: 0.1 mmol/L (blood with HCT 32 %)
Calcium flow (Ca) 0; 1–100 mL/h Syringe pump (anticoagulants)
Calcium dose 0–3.0 mmol/L filtrate Continuous flow 0.5–25 mL/h
(calcium/filtrate) Increments: 0.1 mmol/L
Resolution 0.1 mL/h
Balance Accuracy for flow ± 5%
Number of scales 4 between 1 and 25 mL/h
Measurement principle gravimetric Bolus 0.1–5 mL/bolus
Load capacity per scale max. 12 kg Bolus flow 30 mL/min
Resolution per scale 1g External connection
Linearity deviation max. ±1% LAN-connector: RJ 45 Interface for data exchange
Maximum balancing deviation < 100 mL/h Electrically isolated by transformer

Total balance error Adult: max. 500 g Alarm output Potential-free alarm output

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Phone: (852) 2583 0888 . Fax: (852) 2583 0200 . www.freseniusmedicalcare.asia