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.