Protocol inventor
Developed a simplified dilute 0.5% trisodium citrate approach that replaced complex compounding with a standardized ICU-ready anticoagulant and replacement fluid.
Ashita Tolwani, MD
Global CRRT and regional citrate anticoagulation consulting.
Peer-to-peer advisory and hospital program design—built from patented citrate protocol innovation and the UAB CRRT Academy.
Portrait unavailable
Edwin A. Rutsky Endowed Chair in Nephrology · UAB
Clinical authority
The record hospitals already know before the first call.
Professor of Medicine at the University of Alabama at Birmingham. Co-Director of Critical Care Nephrology. MS Clinical Epidemiology, Harvard School of Public Health.
Global impact
From patented protocol to worldwide ICU practice.
Dr. Tolwani’s dilute citrate innovation, published protocols, and the UAB CRRT Academy have shaped how hospitals launch and sustain regional citrate anticoagulation programs across continents.
Intellectual property
US6566402B2
Patented trisodium citrate dialysate for extracorporeal anticoagulation—foundation for simplified dilute RCA in CRRT.
View patent →Global distribution
Regiocit · Prismocitrate 18/0
Commercialized dilute citrate solutions used in Canada, Europe, India, Singapore, Malaysia, Australia, and New Zealand.
Teaching infrastructure
UAB CRRT Academy
Founder and Director of a multidisciplinary curriculum—didactics, simulation, and hands-on workshops for global ICU teams.
Academy overview →International reach
- North America Institutional workshops & academy alumni
- Europe RCA program adoption & teaching
- Asia-Pacific Singapore · Malaysia · Australia · New Zealand
- South Asia India clinical distribution & training
- South America Keynote & program design engagements
Selected publications & proceedings
- A Practical Citrate Anticoagulation CVVHDF Protocol for Metabolic Control and High Solute Clearance Clinical Journal of the American Society of Nephrology
- Proceedings of the 2022 UAB CRRT Academy: POCUS & Extracorporeal Blood Purification Blood Purification · Karger
- Proceedings of the UAB CRRT Academy (2023–2024) Kidney360
- Proceedings of the UAB CRRT Academy (2023–2024) — open access PMC
Services
Three focuses. One standard of care quality.
Engagements are educational and systemic. The local treating clinician retains full diagnostic and therapeutic responsibility.
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01
CRRT & RCA program design
Hospital-wide protocol architecture, citrate monitoring pathways, filter longevity strategy, and nursing workflow design for regional citrate anticoagulation.
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02
Pharmacokinetic dosing advisory
Effluent-based clearance reasoning and evidence-aligned antimicrobial dosing support for pharmacists and nephrologists managing critically ill patients on CRRT.
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03
POCUS-guided fluid strategy
Integration of lung ultrasound, IVC assessment, and VExUS into ultrafiltration targets—so fluid removal follows congestion physiology, not guesswork.
How we engage
Modalities built for clinicians, contracts, and compliance.
Asynchronous peer review
Clinician-only case submission with de-identified labs and protocol questions—built for global time zones.
Highest scalabilityScheduled advisory calls
Curbside clinician-to-clinician conversations for troubleshooting, prior auth discussions, and corporate advisory.
Premium hourlyInstitutional site visits
On-site CRRT program launches, simulation bootcamps, and keynote teaching for hospital systems.
$10,000–$25,000 / visitClinical tools
Educational calculators for CRRT teams.
Built for shared clinical reasoning—not as standalone bedside decision support. Local protocols and judgment always govern care.
Dose (mL/kg/h) = (Qd + Qr,pre + Qr,post + Quf) ÷ weight
Delivered effluent dose
—mL/kg/h
Diffusive (Qd)
—
Convective
—
Total effluent
—
Enter weight and at least one flow rate.
- Increase dialysate flow (Qd) to raise diffusive clearance without increasing convective fluid exchange.
- Increase replacement fluid rates to raise convective clearance; confirm blood-flow capacity and filter pressure limits.
- Confirm prescribed vs delivered dose—downtime, clotting, and access issues commonly reduce delivered dose below prescription.
- Reassess net ultrafiltration separately from solute clearance goals when fluid balance is the primary constraint.
Citrate delivery (mmol/L blood) = (Qcit × [citrate]) ÷ (Qb × 0.06 × 1000)
Citrate delivery
—mmol/L blood
Blood processed
—
Citrate infused
—
Enter blood flow and citrate infusion rate.
- Increase Qcit or reduce Qb to raise mmol citrate per liter of blood—confirm filter pressures and metabolic monitoring.
- Match citrate rate to blood flow so circuit anticoagulation stays in your protocol target band.
- Watch systemic ionized calcium and the total-to-ionized calcium ratio when increasing citrate delivery.
- Use your institutional RCA protocol for exact targets; solution labels and compounding differ by region.
Total-to-ionized calcium ratio
—
Enter both values to calculate.
- Reduce pre-blood pump citrate infusion rate to lower systemic citrate load.
- Match blood flow to the reduced citrate rate while preserving circuit anticoagulation targets.
- Track systemic pH and bicarbonate to distinguish accumulation from excess citrate metabolism.
- Consider transitioning off RCA if ionized hypocalcemia persists or the ratio continues to rise.
Begin an inquiry
Clinician-to-clinician consultation only.
Healthcare providers may request peer-to-peer educational consultation. Patients are redirected. Local treating clinicians retain full responsibility for care.
Who is requesting?
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