Clinical and biological profiles associated with the time of occurrence of citrate accumulation in patients receiving continuous renal replacement therapy
Authors' conclusion
CA is a rare phenomenon in patients under RCA-CRRT. Severe metabolic acidosis with hyperlactatemia at CRRT initiation is the most relevant marker to identify patients at risk of immediate CA
Study context
- Population
- Critically ill patients treated with RCA-CRRT in nine intensive care units (ICUs) in Lyon, France, January 2020–January 202276 developed citrate accumulation (CA)
- Participants
- 2,080 patients
- Exposure
- Initial CA vs late-onset CA; immediate CA vs early CA
- Initial CAn = 69
- Late-onset CAn = 7reference
- Outcome
- Incidence of CA (tCa/iCa ≥ 2.3 with hypocalcemia and metabolic acidosis)
Methodological detailsmulticentre, observational
- Multicentre
- Observational
Main finding
As reported in the abstract
- Patients developing CA
- 76 (3.7%)
Observational data: associations, not effects.
Further findings
Lactate at CRRT initiation · only variable differing · spread printed in brackets, kind not specified
P = 0.006
- Timing within initial CA (subgroup): Immediate CA (≤6 h) 57%
- Timing within initial CA (subgroup): Early CA (6–24 h) 43%
- Prediction of immediate CA (ROC): Lactate AUC 0.75 [0.62 - 0.87] · optimal cutoff 10.6 mmol/L
- Prediction of immediate CA (ROC): pH AUC 0.74 [0.62 - 0.85] · optimal cutoff 7.14
- ICU mortality: Patients with CA 97%
- ICU mortality: Whole cohort 55%
Timing within initial CA (subgroup)
- Immediate CA: higher lactate and more severe metabolic acidosis at continuous renal replacement therapy (CRRT) initiation vs early CA; other markers not significantly different
Course over first 24 h in initial CA
- Marked increase in lactate, worsening norepinephrine requirements, persistent elevated tCa/iCa, decreased prothrombin time, increased transaminases
Original publication
Clinical and biological profiles associated with the time of occurrence of citrate accumulation in patients receiving continuous renal replacement therapy. Crit Care. Published 26 September 2025. doi:10.
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