Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

ASAIO Journal

Abstract

Background: Continuous kidney replacement therapy (CKRT) is the preferred dialysis modality for critically ill patients with hemodynamic instability. Anticoagulation is often necessary to deliver CKRT effectively and prolong the circuit lifespan. The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury 2012 recommends regional citrate administration during CKRT for patients without contraindications to prevent filter clotting. Citrate works by chelating calcium and interfering with the activation of the coagulation cascade. This study evaluated effectiveness and safety of fixed (FIX) versus variable citrate rate (VAR) in critically ill patients receiving CKRT. Methods: This single-center, retrospective study evaluated adult patients, age ≥18 years, admitted to the ICU between 7/1/2018 – 6/30/2024 who received CKRT with regional citrate anticoagulation ≥ 24 hours. Excluded patients were COVID-19 positive. Regional citrate is prescribed at either a fixed dose of 300 mL/hr or variable dose (1.5 x initial blood flow rate) that is titrated based on post-dialysis filter ionized calcium levels to a target of 1.0-1.6 mg/dL. FIX ECMO patients were case-matched to VAR non-ECMO patients based on pulmonary or cardiac diagnosis and duration of citrate. Data were analyzed with SPSS v.29.0 with a p-value < 0.05 being considered statistically significant. Results: Of the 442 patients screened, 20 patients (10 FIX ECMO, 10 VAR non-ECMO) were similar in age, (49.3 ± 16.2 FIX vs 60.8 ± 16.2 VAR, years, p=0.13) and citrate duration (6.0 [4.3, 10.5] FIX vs 5.0 [3.8, 6.7] VAR, days, p=0.05). The primary outcome of time from citrate initiation to first CKRT filter change was similar, 0.8 [0.5, 2.8] FIX vs 2.3 [0.7, 2.9] VAR, days, p=0.46. Within the first 7 days of citrate therapy, hypocalcemia occurred frequently, 100% FIX and 90% VAR, p=0.99 with calcium replacement more likely with VAR, 50% FIX vs 100% VAR, p=0.03. Bleeding (p=0.99), thrombosis (p=0.47) events, and ICU and hospital length of stay were similar. Conclusions: This study provides real-world data comparing fixed versus variable rate of citrate in CKRT in ECMO versus non-ECMO patients, respectively. Both fixed and variable citrate rate strategies in CKRT showed more calcium replacement with VAR and no significant differences in filter lifespan, ICU outcomes, or major adverse events.

Volume

72

Issue

Suppl 5

First Page

173

Last Page

173

Comments

American Society for Artificial Internal Organs ASAIO 72nd Annual Conference, June 17-20, 2026, Fort Lauderdale, FL

DOI

10.1097/MAT.0000000000002751

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