Journal of Critical and Intensive Care
2023 , Vol 14, Issue 1
Regional Citrate Anticoagulation: Basic Principles and Clinical Applications
1Gazi University School of Medicine, Department of Internal Medicine, Division of Intensive Care, Ankara, Turkey
DOI :
10.37678/dcybd.2023.2324
Regional citrate anticoagulation (RCA) provides effective anticoagulation within the circuit through calcium
chelation during CRRT applications. Although it provides an advantage to avoid the side effects of the systemic
anticoagulation, RCA application rates remain low in practice due to the fact that there are some metabolic
side effects specific to citrate and the need for comprehensive protocols to perform the procedure and prevent
the citrate-related metabolic derangements. Acknowledgement about the basic principles of RCA, citrate
metabolism and citrate-related metabolic side effects will help the clinician to manage RCA successfully as
well as recognize the risky patients on time. In this review, the basic principles and metabolic side effects of
RCA will be summarized to contribute to daily practice, and the possible difficulties and pitfalls about citrate
implementation will be mentioned.
Keywords :
continuous renal replacement therapy, regional citrate anticoagulation, metabolic derangements, citrate accumulation, net citrate overload