Incidence, severity, and predictors of citrate accumulation during continuous kidney replacement therapy in the critically ill
Authors' conclusion
Lactate is a reliable predictor for assessing the risk of citrate accumulation in patients undergoing CKRT.
Study context
- Population
- Critically ill patients requiring regional citrate anticoagulation (RCA)-based continuous kidney replacement therapy (CKRT), January 2018–March 2022
- Participants
- 911 patients
- Outcome
- Citrate accumulation (albumin-corrected total calcium to ionized calcium ratio ≥ 2.5)
Main finding
As reported in the abstract
Incidence of citrate accumulation
Citrate accumulation
159
17%
Observational data: associations, not effects.
Further findings
| Outcome | Odds increase (CI) | P value | |
|---|---|---|---|
| Lactate before CKRT onset as predictor of citrate accumulation (per one-unit increase in log mmol/L) | 2.34 (1.94–2.85) | P < 0.001 | |
| −2024Difference (linear scale) |
Lactate before CKRT onset as predictor of citrate accumulation (per one-unit increase in log mmol/L)
- Lactate showed improved discriminative performance vs vasoactive inotropic score (VIS)
Probability of citrate accumulation by lactate level
%
- Probability at lactate 0.3 mmol/L
- 3.3 (CI 2.06-5.28)
- Probability at lactate 25 mmol/L
- 59.8 (CI 48.88-69.78)
Predictors: liver dysfunction and circulatory shock
- Factors related to liver dysfunction, but not circulatory shock, attributed to citrate accumulation
Mortality
- Citrate accumulation not associated with mortality after multivariable adjustment
Original publication
Incidence, severity, and predictors of citrate accumulation during continuous kidney replacement therapy in the critically ill. Crit Care. Published 3 November 2025. doi:10.
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