Complications of regional citrate anticoagulation: accumulation or overload?

• Published in: Critical care (London, England) Vol. 21; no. 1; p. 281
• Main Authors: Schneider, Antoine G, Journois, Didier, Rimmelé, Thomas
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19-11-2017; BioMed Central; BMC
• Subjects: Acids; Acute kidney injury; Anticoagulants; Anticoagulants (Medicine); Blood; Citrate accumulation; Complications and side effects; Complications of therapy; Continuous renal replacement therapy; Critical care; Dosage and administration; Hemodialysis; Liver; Medical examination; Metabolic alkalosis; Metabolism; Patients; Regional citrate anticoagulation; Viewpoint; Citrate accumulation; Complications of therapy; Regional citrate anticoagulation; Acute kidney injury; Metabolic alkalosis; Continuous renal replacement therapy
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-017-1880-1

Regional citrate anticoagulation (RCA) is now recommended over systemic heparin for continuous renal replacement therapy in patients without contraindications. Its use is likely to increase throughout the world. However, in the absence of citrate blood level monitoring, the diagnosis of citrate accumulation, the most feared complication of RCA, remains relatively complex. It is therefore commonly mistaken with other conditions. This review aims at providing clarifications on RCA-associated acid-base disturbances and their management at the bedside. In particular, the authors wish to propose a clear distinction between citrate accumulation and net citrate overload.