Ready4 Ci-Ca: Innovation in clinical education
Fresenius Medical Care (FME) recently marked 20 years of experience with Ci-Ca therapy in Europe. Ci-Ca therapy is a continuous kidney replacement therapy (CKRT) that uses regional citrate anticoagulation (RCA) supported by machine-integrated citrate and calcium management. Developed in collaboration with experienced clinicians, this approach is designed to provide reliable anticoagulation during CKRT through the multiFiltratePRO.
Although many clinicians consider RCA a safer option for CKRT — and guidelines such as KDIGO1 recommend citrate over heparin when no contraindications exist — its regular use remains limited. Only about one third of CKRT treatments globally employ citrate anticoagulation. Some barriers to adoption include staff training requirements, perceived complexity, and unfamiliarity with citrate protocols. Because healthcare professionals in critical care settings often face complex treatment decisions that need to be made quickly, many report that the learning curve associated with citrate anticoagulation is challenging to overcome.
The Ready4 Ci-Ca Simulator was created to address these challenges by offering a structured, transparent way to explore Ci-Ca therapy principles and support healthcare professionals in deepening their understanding of Ci-Ca, thereby empowering them to make well-considered decisions about patient care, even in stressful conditions.
The Ready4 Ci-Ca Simulator
By combining the physiological processes of citrate metabolism with the physical principles of solute transfer in dialysis, Fresenius Medical Care, developed an algorithm that accurately predicts the trajectory of bicarbonate and sodium levels over the complete treatment time in critically ill patients undergoing CKRT with RCA.2
This algorithm was used to create a simulation model in partnership with clinicians and researchers in Switzerland. This model has been retrospectively validated with 965 patients and over 24,400 measurements and is now available for training and education in our interactive Ready4 Ci-Ca Simulator.
As part of the broader Ready4 educational initiative, which focuses on training and knowledge development in acute kidney care, the Ready4 Ci-Ca Simulator is an interactive training tool that is available online and designed to help clinicians understand how Ci-Ca therapy influences patient’s sodium and acid-base levels during CKRT. It provides a visual, model based environment where users can explore treatment scenarios and observe how different prescription choices affect bicarbonate and sodium levels over the course of therapy. Its key capabilities include:
- Converts Ci-Ca treatment settings into clear, visual simulations
- Shows the general relationship between treatment settings and their impact on patient conditions
- Supports better understanding of Ci-Ca therapy principles and clinical knowledge with an accessible knowledge base
- Quick access to content that highlights typical patterns in unusual situations
- Offers healthcare professionals deeper insight and confidence for CKRT
- Available online, ready for clinicians and healthcare teams at any time
Moving toward more personalized care
Fresenius Medical Care is continuing to expand its Ci-Ca educational framework, which is aimed at supporting personalized prescription decisions. The goal is to provide clinicians with tools that clarify treatment relationships, improve understanding of therapy parameters, and support consistent decision making in critical care settings.
The Ready4 Ci-Ca Simulator is one more step in this effort by:
- Enhancing understanding of treatment interdependencies
- Making treatment settings more transparent
- Providing a stronger foundation for informed decision making and thereby creating confidence in Ci-Ca
“Clinicians can now make better-informed decisions when they can see a patient’s underlying physiology with full transparency,” says David Thompson, DO, Medical Officer of Critical Care at Fresenius Medical Care, Medical Affairs. “The Ready4 Ci-Ca Simulator was developed to support that kind of insight. By translating complex data and metabolic processes into an accessible learning experience, it helps clinicians deepen their understanding of Ci-Ca therapy and approach critical care with greater clarity and confidence.”
Further developments in Ci-Ca education and support tools are planned. After twenty years of working with Ci-Ca therapy, we remain committed to equipping healthcare professionals with the knowledge and confidence needed to apply citrate anticoagulation safely and effectively.
Publication date: May 2026
Related content
1 KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012;s2:1–138.
2 Müller MM et al. Journal of the American Society of Nephrology 36(10S):10.1681/ASN.2025g1az3hcp; Abstract