Key result
Total-to-ionized calcium ratio ≥ 2.5 identifies citrate accumulation during regional citrate anticoagulation in CRRT.
Why the study?
Citrate accumulation during regional citrate anticoagulation for continuous renal replacement therapy represents a major clinical challenge requiring better understanding of mechanisms and management.
This narrative review summarizes the mechanisms, diagnosis, and management of citrate accumulation during RCA-CRRT to optimize safety and efficacy.
Regional citrate anticoagulation (RCA) has been increasingly adopted as a preferred anticoagulation strategy in continuous renal replacement therapy (CRRT). However, Citrate accumulation during RCA-CRRT represents a major clinical challenge. This review provides an overview of the mechanisms underlying citrate accumulation, its diagnostic criteria, and the primary factors contributing to citrate accumulation, including excessive citrate infusion dose, insufficient citrate loss across the filter, impairment of citrate metabolism. In addition, the clinical consequences of citrate accumulation and current management strategies are summarized, aiming to provide insights for optimizing the safety and efficacy of RCA-CRRT.
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Chen et al. (2026) conducted a review in Citrate accumulation during regional citrate anticoagulation for continuous renal replacement therapy. Regional citrate anticoagulation was evaluated. Citrate accumulation during regional citrate anticoagulation for continuous renal replacement therapy is a major clinical challenge diagnosed primarily by a total-to-ionized calcium ratio ≥ 2.5.
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