Evidence map›Paper›PMID 42129846›Full record

ReviewCritical care (London, England)2026

Metabolic complications of citrate anticoagulation in continuous renal replacement therapy (crrt): a delphi consensus on indications, monitoring and management.

Rita Jacobs, Antoine Schneider, Eric Hoste, Walter Verbrugghe, Sean Bagshaw, Max Bell, Willem Boer, Josee Bouchard, Marcus Broman, Brendan Crawford and 19 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors.

Rita JacobsDepartment of Critical Care Medicine, Antwerp University Hospital, UZA, Drie Eiken Straat 655, Edegem, B-2650, Belgium. rita.jacobs2@uza.be.
Antoine SchneiderAdult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Eric HosteIntensive Care Unit, Dept of Internal Medicine and Paediatrics, Ghent University Hospital, Ghent University, C. Heymanslaan 10, Gent, Belgium.
Walter VerbruggheDepartment of Critical Care Medicine, Antwerp University Hospital, UZA, Drie Eiken Straat 655, Edegem, B-2650, Belgium.
Sean BagshawDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada.
Max BellDepartment of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Willem BoerDepartment of Anaesthesiology, Intensive Care Medicine, Emergency Medicine & Pain Medicine, Ziekenhuis Oost Limburg ZOL, Genk, Belgium.
Josee BouchardProfessor of Medicine, FRCPC Nephrologist, University of Montreal, Montreal, Canada.
Marcus BromanÖverläkare Docent Perioperative and Intensive Care, Skåne University Hospital, Lund, Sweden.
Brendan CrawfordDivision of Pediatric Nephrology, University of Arkansas Medical Sciences, Little Rock, AR, USA.
Sascha DavidInstitute of Intensive Care Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Francesca Di MarioAzienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Olivier Joannes-BoyauService d'Anesthésie‑Réanimation Thoraco-abdominal, Centre Médico- Chirurgical Magellan, CHU de Bordeaux, Bordeaux, France.
Michael JoannidisDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
Catherine JosephDivision of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Kyle A MerrillUniversity of Iowa Carver College of Medicine, Iowa City, IA, USA.
Marlies OstermannDepartment of Intensive Care, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK.
Paul PalevskyDeputy National Program Executive Director, University of Pittsburgh School of MedicineVHA Kidney Medicine Program, Pittsburgh, USA.
Karen PapezAcute Care Nephrology, Phoenix Children's, Phoenix, AZ, USA.
John ProwleFaculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
Oleksa RewaDepartment of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Zaccaria RicciDepartment of Emergency and Critical Care, Anesthesia and Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy.
Stella ShinDepartment of Pediatrics Atlanta, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
Balazs SzamosfalviDivision of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Ashita TolwaniDivision of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Gianluca VillaSection of Anesthesiology, Intensive Care and Pain Medicine, Department of Health Sciences, Department of Anesthesia and Intensive Care, University of Florence, AOU Careggi, Florence, Italy.
Meint VolbedaDepartment of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Thomas RimmeléIntensive Care Medicine, Hôpital Pasteur, Nice, France.
Philippe G JorensDepartment of Critical Care Medicine, Antwerp University Hospital, UZA, Drie Eiken Straat 655, Edegem, B-2650, Belgium.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRegional citrate anticoagulation (RCA) is recommended by guidelines over systemic heparinization for continuous renal replacement therapy (CRRT). However, its use in patients with impaired citrate metabolism poses specific challenges and standardized guidance for managing RCA-related metabolic complications remains lacking.

methodsA modified Delphi study was conducted according to a predefined protocol and reported in adherence with the CREDES (Conducting and REporting of DElphi Studies) checklist. The international expert panel comprised 29 clinicians and researchers from Europe, United States and Canada, with recognized expertise in RCA for CRRT in critically ill patients. Three iterative survey rounds were conducted to obtain agreement with proposed statements.

resultsTwenty-three experts completed all Delphi rounds, achieving consensus on twenty-two statements. RCA was considered feasible in patients with liver dysfunction, severe shock, or hyperlactatemia, with close monitoring and citrate dosing adjustment. Citrate accumulation can be prevented and managed using a stepwise approach, focused on reducing citrate delivery and discontinuing RCA in cases of overt accumulation. Metabolic alkalosis and electrolyte disturbances were identified as relevant but manageable complications, underscoring the need for individualizing CRRT settings.

conclusionThese consensus statements support the use of RCA during CRRT in critically ill patients with impaired citrate metabolism and provide practical guidance for monitoring and management of metabolic complications. However they reflect expert opinion, especially for questions with limited data and low-level evidence.

Indexed as

AnticoagulantsCitric AcidContinuous Renal Replacement TherapyRenal Replacement TherapyConsensusCritical IllnessDelphi TechniqueHumansMonitoring, PhysiologicSurveys and QuestionnairesAnticoagulantsCitric AcidAcute kidney injuryCitrate anticoagulationContinuous renal replacement therapyDelphiMetabolic complications

Identifiers

PMID42129846
PMCPMC13340270

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

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.