ArticleCritical care (London, England)2025
Incidence, severity, and predictors of citrate accumulation during continuous kidney replacement therapy in the critically ill.
Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Citrate accumulation during regional citrate anticoagulation for continuous renal replacement therapy: a narrative review.Renal failure · 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
- Should we change our approach to detecting citrate accumulation in patients treated with CRRT with regional citrate?Critical care (London, England) · 2026Article
- Beyond static thresholds: the "citrate challenge" as a physiology-guided bedside framework.Critical care (London, England) · 2026Article
- Albumin-corrected tCa/iCa ratio: are we still diagnosing citrate accumulation or predicting mortality?Critical care (London, England) · 2026Article
- Albumin-corrected calcium ratios for citrate accumulation increase detection and improve mortality prediction in continuous kidney replacement therapy.Critical care (London, England) · 2026Article
- Challenging the citrate challenge: why we need global criteria to define citrate accumulation.Critical care (London, England) · 2026Article
- Citrate accumulation during CRRT: the impact of diagnostic criteria.Critical care (London, England) · 2026Article
- Disenchantment: the overstated impact of citrate concentration on accumulation risk.Critical care (London, England) · 2026Article
- Unraveling the true determinants of citrate accumulation in continuous kidney replacement therapy: the overlooked role of citrate concentration and dilution modality.Critical care (London, England) · 2025Article
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15 authors.
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Abstract
backgroundRegional citrate anticoagulation (RCA) is the recommended anticoagulation strategy for continuous kidney replacement therapy (CKRT). However, the safety of RCA in patients with liver dysfunction and/or shock remains controversial due to the risk of citrate accumulation. This study assesses the associations of citrate accumulation with liver dysfunction, circulatory shock, and mortality, and investigates lactate and the vasoactive inotropic score (VIS) as early predictors.
methodsThis retrospective cohort study included critically ill patients requiring RCA-based CKRT between January 2018 and March 2022. Lactate, VIS and parameters of organ failure were investigated as predictors of citrate accumulation. An albumin-corrected total calcium to ionized calcium ratio ≥ 2.5 was used to define citrate accumulation. Regression models were employed to investigate the association of predictors with outcomes.
resultsNine hundred eleven patients were included, citrate accumulation was observed in 159 individuals (17%). Factors related to liver dysfunction, but not circulatory shock, were attributed to citrate accumulation. After multivariable adjustment, citrate accumulation was not associated with mortality. Lactate measured before onset of CKRT showed an improved discriminative performance compared to the VIS. The odds of citrate accumulation increased by 2.34 (CI 1.94–2.85, p < 0.001) for each one-unit increase in lactate on the logarithmic scale (log mmol/L). The probability for citrate accumulation ranged from 3.3 (CI 2.06–5.28) % at lactate levels of 0.3 mmol/L to 59.8 (CI 48.88–69.78) % at levels of 25 mmol/L.
conclusionLactate is a reliable predictor for assessing the risk of citrate accumulation in patients undergoing CKRT. Further research is needed to develop and validate predictive algorithms for various anticoagulation strategies to offer reliable support for personalized decision-making in clinical practice.
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