ReviewCritical care (London, England)2011
Clinical review: anticoagulation for continuous renal replacement therapy--heparin or citrate?
Review in Critical care (London, England), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 77 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Study on the Efficacy and Safety of Continuous Renal Replacement Therapy (CVVHDF) Using a Commercial Citrate-containing Replacement Fluid (Prismocitrate 18/0)
Simplified Regional Citrate Anticoagulation Protocols for CVVH, CVVHDF and SLED Focused on the Prevention of RRT-related Hypophosphatemia and Optimization of Acid-base Balance: a Pilot Study
Citrate Versus Heparin in Continuous Renal Replacement Therapy : Effect on Cardiovascular System and Clot Circuit in Critically Ill Patients
Oxidative Stress and Circulating Nuclear DNA (cfDNA) in Acute Kidney Injury and Continuous Renal Replacement Therapies. Effect of Two Anticoagulation Strategies of the Extracorporeal Purification System in Renal Function Recovery.
Who cites it
77 citing papers in PubMed, 6 syntheses or guidelines pooled it, 189 citations in OpenAlex.
- Nafamostat mesilate as anticoagulant for blood purification: a systematic review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Anticoagulation options for continuous renal replacement therapy in critically ill patients: a systematic review and network meta-analysis of randomized controlled trials.Critical care (London, England) · 2023Pooled it
- Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis.Critical care (London, England) · 2019Pooled it
- Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis.BMC nephrology · 2017Pooled it
- Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a meta-analysis with trial sequential analysis of randomized controlled trials.Critical care (London, England) · 2016Pooled it
- Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs.Intensive care medicine · 2015Pooled it
- The effect of citrate in cardiovascular system and clot circuit in critically ill patients requiring continuous renal replacement therapy.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2023Trial
- Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study.International urology and nephrology · 2016Trial
- Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy: a randomized controlled trial.Critical care (London, England) · 2015Trial
- Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis.Intensive care medicine · 2013Trial
- Treatment Effect of Regional Sodium Citrate Anticoagulation in Elderly Patients With High-Risk Bleeding Receiving Continuous Renal Replacement Therapy.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisTrial
- Simplified Citrate Anticoagulation for CRRT Without Calcium Replacement.ASAIO journal (American Society for Artificial Internal Organs : 1992)Trial
- Comparison of citrate anticoagulation strategies in hemodialysis patients at high risk of bleeding: a prospective observational cohort study.Renal failure · 2026Observational
- Systemic Citrate Toxicity During Regional Citrate Anticoagulation for Continuous Kidney Replacement Therapy.Journal of clinical medicine · 2026Review
- The Safety of Pre-Filter Heparin for Circuit Clotting Prevention in Continuous Renal Replacement Therapy: A Retrospective Evaluation.Journal of clinical medicine · 2026Article
- Comparative efficacy and safety of anticoagulation strategies in continuous renal replacement therapy: a real-world cohort study.BMC nephrology · 2026Article
- Regional citrate versus systemic heparin anticoagulation in continuous renal replacement therapy for sepsis-associated acute kidney injury: A retrospective cohort study of short-term outcomes.The Journal of international medical research · 2026Article
- Metabolic complications of citrate anticoagulation in continuous renal replacement therapy (crrt): a delphi consensus on indications, monitoring and management.Critical care (London, England) · 2026Review
- Reply to: Effective buffers in intravenous solutions: reconciling the acid-base effects of organic anions.Critical care (London, England) · 2026Article
- Buffers in intravenous solutions: is the source of bicarbonate a source of confusion?Critical care (London, England) · 2025Review
17 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Heparin is the most commonly prescribed anticoagulant for continuous renal replacement therapy. There is, however, increasing evidence questioning its safety, particularly in the critically ill. Heparin mainly confers its anticoagulant effect by binding to antithrombin. Heparin binds to numerous other proteins and cells as well, however, compromising its efficacy and safety. Owing to antithrombin consumption and degradation, and to the binding of heparin to acute phase proteins, and to apoptotic and necrotic cells, critical illness confers heparin resistance. The nonspecific binding of heparin further leads to an unpredictable interference with inflammation pathways, microcirculation and phagocytotic clearance of dead cells, with possible deleterious consequences for patients with sepsis and systemic inflammation. Regional anticoagulation with citrate does not increase the patient's risk of bleeding. The benefits of citrate further include a longer or similar circuit life, and possibly better patient and kidney survival. This needs to be confirmed in larger randomized controlled multicenter trials. The use of citrate might be associated with less inflammation and has useful bio-energetic implications. Citrate can, however, with inadequate use cause metabolic derangements. Full advantages of citrate can only be realized if its risks are well controlled. These observations suggest a greater role for citrate.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.