SynthesisCritical care (London, England)2019
Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis.
Synthesis in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04351438 (Prismaflex Therapeutic Plasma Exchange), which is not on this map. Cited by 55 papers, 5 of them syntheses that pooled it.
What it found
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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.
Prismaflex Therapeutic Plasma Exchange: Evaluation of Complication Rates Using Filter vs. Centrifuge and Heparin vs. Citrate Anticoagulation
Who cites it
55 citing papers in PubMed, 5 syntheses or guidelines pooled it, 136 citations in OpenAlex.
- [S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.Hepatology international · 2024Guideline
- 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
- Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus.Military Medical Research · 2023Guideline
- Regional Citrate Anticoagulation or Heparin Anticoagulation for Renal Replacement Therapy in Patients With Liver Failure: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Standard vs. carbone dioxide adapted kidney replacement therapy in hypercapnic ARDS patients: a randomized controlled pilot trial (BigBIC).Critical care (London, England) · 2024Trial
- Customized Citrate Anticoagulation versus No Anticoagulant in Continuous Venovenous Hemofiltration in Critically Ill Patients with Acute Kidney Injury: A Prospective Randomized Controlled Trial.Blood purification · 2023Trial
- Citrate accumulation during regional citrate anticoagulation for continuous renal replacement therapy: a narrative review.Renal failure · 2026Review
- Real-World Safety and Circuit Outcomes of Protocolized Divided-Dose Enoxaparin During Continuous Renal Replacement Therapy Without Routine Anti-Xa Monitoring: A Single-Center Competing-Risk Cohort Study.Journal of clinical medicine · 2026Article
- Prevalence of bone mineral disease in children with acute kidney disease on continuous kidney replacement therapy: a case-control study.Pediatric nephrology (Berlin, Germany) · 2026Article
- Article
- Critical care considerations in rhabdomyolysis-associated acute kidney injury and kidney replacement therapy.World journal of nephrology · 2026Review
- Metabolic complications of citrate anticoagulation in continuous renal replacement therapy (crrt): a delphi consensus on indications, monitoring and management.Critical care (London, England) · 2026Review
- Article
- Multidisciplinary guidelines on renal replacement therapy in intensive care medicine.Critical care (London, England) · 2026Review
- Effects of different continuous renal replacement therapy patterns on ionized calcium in patients with citrate anticoagulants using calcium-containing replacement solutions: a study protocol.Annals of medicine · 2025Article
- Sustained low-efficiency dialysis-an old method but possibly a new solution for environmental nephrology.Renal failure · 2025Review
- Incidence, severity, and predictors of citrate accumulation during continuous kidney replacement therapy in the critically ill.Critical care (London, England) · 2025Article
- Successful application of innovative hybrid anticoagulation in continuous renal replacement therapy for an ultra-elderly patient: a case report.BMC nephrology · 2025Article
- Clinical and biological profiles associated with the time of occurrence of citrate accumulation in patients receiving continuous renal replacement therapy.Critical care (London, England) · 2025Observational
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundRegional citrate anticoagulation (RCA) is a widely used strategy for continuous renal replacement therapy (CRRT). Most of the current guidelines recommend liver failure as one of the contraindications for citrate anticoagulation. However, some studies suggested that the use of citrate for CRRT in liver failure patients did not increase the risk of citrate-related complications. The purpose of this systematic review is to summarize the current evidences on the safety and efficacy of RCA for CRRT in liver failure patients.
methodsWe performed a comprehensive search on PubMed, Embase, and the Cochrane Library databases from the inception to March 1, 2018. Studies enrolled adult (age > 18 years) patients with various levels of liver dysfunction underwent RCA-CRRT were included in this systematic review.
resultsAfter the study screening, 10 observational studies with 1241 liver dysfunction patients were included in this systematic review. The pooled rate of citrate accumulation and bleeding was 12% [3%, 22%] and 5% [2%, 8%], respectively. Compared with the baseline data, the serum pH, bicarbonate, and base excess (BE), the rate of metabolic alkalosis, the serum ionized calcium (ionCa) and total calcium (totCa) level, and the ratio of total calcium/ionized calcium (totCa/ionCa) significantly increased at the end of observation. However, no significant increase was observed in serum citrate (MD - 65.82 [- 194.19, 62.55]), lactate (MD 0.49 [- 0.27, 1.26]) and total bilirubin concentration (MD 0.79 [- 0.70, 2.29]) at the end of CRRT. Compared with non-liver failure patients, the live failure patients showed no significant difference in the pH (MD - 0.04 [- 0.13, 0.05]), serum lactate level (MD 0.69 [- 0.26, 1.64]), and totCa/ionCa ratio (MD 0.03 [- 0.12, 0.18]) during CRRT. The median of mean filter lifespan was 55.9 h, with a range from 22.7 to 72 h.
conclusionsRegional citrate anticoagulation seems to be a safe anticoagulation method in liver failure patients underwent CRRT and could yield a favorable filter lifespan. Closely monitoring the acid base status and electrolyte balance may be more necessary during RCA-CRRT in patients with liver failure.
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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.