ArticleClinical journal of the American Society of Nephrology : CJASN2013
Efficacy and safety of a citrate-based protocol for sustained low-efficiency dialysis in AKI using standard dialysis equipment.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03976440 (Simplified Regional Citrate Anticoagulation Protocols for CVVH, CVVHDF and SLED Focused on the Prevention of RRT-related Hypophosphatemia and Optimization of Acid-base Balance), which is not on this map. Cited by 34 papers, 1 of them a synthesis that pooled it.
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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.
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
Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- A Systematic Bibliometric Analysis of High-Impact Articles in Critical Care Nephrology.Blood purification · 2024Pooled it
- Comparison of citrate anticoagulation strategies in hemodialysis patients at high risk of bleeding: a prospective observational cohort study.Renal failure · 2026Observational
- Renal replacement therapy in intensive care unit: a narrative review.Annals of intensive care · 2026Review
- Regional citrate anticoagulation ensures safe and effective kidney replacement therapy in metformin-associated lactic acidosis.Clinical kidney journal · 2025Article
- Regional citrate anticoagulation for intermittent renal replacement therapy in critically ill patients: a retrospective case-control study.BMC nephrology · 2025Article
- Sustained Low-Efficiency Dialysis (SLED) with Regional Citrate Anticoagulation (RCA) and new dialysis equipment: a prospective study with serum citrate measurements and electrolyte monitoring.Journal of nephrology · 2025Article
- Deciphering simplified regional anticoagulation with citrate in intermittent hemodialysis: a clinical and computational study.Scientific reports · 2024Article
- Sustained low-efficiency dialysis with regional citrate anticoagulation is a suitable therapeutic option for refractory hypermagnesemia in critically ill patients with AKI.Journal of nephrology · 2024Article
- Quality indicators in prolonged hemodialysis with regional citrate anticoagulation with the genius system: retrospective cohort of critical patients with acute kidney injury.BMC nephrology · 2023Article
- Simplified regional citrate anticoagulation protocol for CVVH, CVVHDF and SLED focused on the prevention of KRT-related hypophosphatemia while optimizing acid-base balance.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Article
- Archetypal sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring kidney replacement therapy: towards an adequate therapy.Journal of nephrology · 2023Review
- Metabolic and nutritional aspects in continuous renal replacement therapy.Journal of intensive medicine · 2023Review
- Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission.Journal of anesthesia, analgesia and critical care · 2023Review
- Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy.Pediatric nephrology (Berlin, Germany) · 2022Article
- Involvement of Tricarboxylic Acid Cycle Metabolites in Kidney Diseases.Biomolecules · 2021Review
- Prevention of hypomagnesemia in critically ill patients with acute kidney injury on continuous kidney replacement therapy: the role of early supplementation and close monitoring.Journal of nephrology · 2021Review
- Sustained low-efficiency dialysis with regional citrate anticoagulation in critically ill patients with COVID-19 associated AKI: A pilot study.Journal of critical care · 2021Article
- Regional citrate anticoagulation for intermittent hemodialysis in the intensive care: what is the optimal setup?Annals of intensive care · 2021Article
- Comparison between regional citrate anticoagulation and heparin for intermittent hemodialysis in ICU patients: a propensity score-matched cohort study.Annals of intensive care · 2021Article
- Molecular Mechanisms of AKI in the Elderly: From Animal Models to Therapeutic Intervention.Journal of clinical medicine · 2020Review
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesA simple anticoagulation protocol was developed for sustained low-efficiency dialysis (SLED) in patients with AKI, based on the use of anticoagulant citrate dextrose solution formulation A (ACD-A) and standard dialysis equipment. Patients' blood recalcification was obtained from calcium backtransport from dialysis fluid. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients treated with SLED (8- to 12-hour sessions) for AKI in four intensive care units of a university hospital were studied over a 30-month period, from May 1, 2008 to September 30, 2010. SLED interruptions and their causes, hemorrhagic complications, as well as coagulation parameters, ionized calcium, and blood citrate levels were recorded.
resultsThis study examined 807 SLED sessions in 116 patients (mean age of 69.7 years [SD 12.1]; mean Acute Physiology and Chronic Health Evaluation II score of 23.8 [4.6]). Major bleeding was observed in six patients (5.2% or 0.4 episodes/100 person-days follow-up while patients were on SLED treatment). Citrate accumulation never occurred, even in patients with liver dysfunction. Intravenous calcium for ionized hypocalcemia (< 3.6 mg/dl or < 0.9 mmol/L) was needed in 28 sessions (3.4%); in 8 of these 28 sessions (28.6%), low ionized calcium was already present before SLED start. In 92.6% of treatments, SLED was completed within the scheduled time (median 8 hours). Interruptions of SLED by impending/irreversible clotting were recorded in 19 sessions (2.4%). Blood return was complete in 98% of the cases. In-hospital mortality was 45 of 116 patients (38.8%).
conclusionsThis study protocol affords efficacious and safe anticoagulation of the SLED circuit, avoiding citrate accumulation and, in most patients, systematic calcium supplementation; it can be implemented with commercial citrate solutions, standard dialysis equipment, on-line produced dialysis fluid, and minimal laboratory monitoring.
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