Advances in the application of hemofiltration replacement fluid of sodium citrate in continuous renal replacement therapy_West China Medical Journal

Authors：

GUAN Jianbin , WANG Guizhong , HUANG Bo ,  LIU Zhanguo

Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China;

Corresponding author：

LIU Zhanguo, Email: zhguoliu@163.com

Keywords：

Continuous renal replacement therapy; regional citrate anticoagulation; hemofiltration replacement fluid of sodium citrate; hemofiltration replacement fluid of sodium bicarbonate and phosphate

DOI：

10.7507/1002-0179.202507001

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Safe and effective anticoagulation is crucial in continuous renal replacement therapy. Citrate anticoagulation is widely used for its advantages of low bleeding risk, high anticoagulation efficacy, and extended filter lifespan. However, the commonly used citrate-containing anticoagulants in clinical practice, such as 4% trisodium citrate, may impose excessive citrate and sodium loads, increasing the risk of metabolic alkalosis and hypernatremia, especially in patients whose replacement fluid electrolytes are not appropriately adjusted. In recent years, the clinical use of low-concentration sodium citrate-based replacement fluids has reduced the incidence of metabolic disturbances. When combined with calcium-free, phosphate-containing, and low-buffer bicarbonate solutions, this approach offers additional benefits such as simplified workflow, reduced circuit complexity, and improved electrolyte stability, achieving both effective anticoagulation and electrolyte homeostasis.

1.	Wu MY, Hsu YH, Bai CH, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a meta-analysis of randomized controlled trials. Am J Kidney Dis, 2012, 59(6): 810-818.
2.	共识专家组. 抗凝技术在危重症肾脏替代治疗应用的中国专家共识(2023 年版). 中华肾脏病杂志, 2023, 39(2): 155-164.
3.	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
4.	中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南. 中华肾脏病杂志, 2022, 38(11): 1016-1024.
5.	崔庆宏, 孙峰, 刘树元, 等. 急诊连续性肾脏替代治疗中局部枸橼酸抗凝应用情况的调查研究. 中华危重病急救医学, 2020, 32(5): 595-600.
6.	Xinping Z, Jie H, Zhenya Y, et al. Citrate anticoagulation in plasma exchange followed by continuous renal replacement therapy in critically ill children. Int J Artif Organs, 2024, 47(2): 85-95.
7.	Poh CB, Tan PC, Kam JW, et al. Regional citrate anticoagulation for continuous renal replacement therapy - a safe and effective low-dose protocol. Nephrology (Carlton), 2020, 25(4): 305-313.
8.	Israni A, Goldfarb DS. Let’s stop talking about ‘citrate toxicity’. Curr Opin Nephrol Hypertens, 2024, 33(2): 181-185.
9.	Di Mario F, Sabatino A, Regolisti G, et al. Simplified regional citrate anticoagulation protocol for CVVH, CVVHDF and SLED focused on the prevention of KRT-related hypophosphatemia while optimizing acid-base balance. Nephrol Dial Transplant, 2023, 38(10): 2298-2309.
10.	Liu SY, Xu SY, Yin L, et al. Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus. Mil Med Res, 2023, 10(1): 23.
11.	Lenga I, Hopman WM, O’Connell AJ, et al. Flexitrate regional citrate anticoagulation in continuous venovenous hemodiafiltration: a retrospective analysis. BMC Nephrol, 2019, 20(1): 452.
12.	Jeffrey YH, Hoi-Ping S, Kit Hung AL, et al. Experiences with continuous venovenous hemofiltration using 18 mmol/L predilution citrate anticoagulation and a phosphate containing replacement solution. Indian J Crit Care Med, 2017, 21(1): 11-16.
13.	胡新, 毛智, 李青霖, 等. 新型含枸橼酸无钙置换液在重症患者血液净化治疗中的抗凝效果. 解放军医学杂志, 2020, 45(12): 1259-1264.
14.	血液净化急诊临床应用专家共识组. 血液净化急诊临床应用专家共识. 中华急诊医学杂志, 2017, 26(1): 24-36.
15.	Fiaccadori E, Sabatino A, Barazzoni R, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr, 2021, 40(4): 1644-1668.
16.	Balik M, Zakharchenko M, Otahal M, et al. Quantification of systemic delivery of substrates for intermediate metabolism during citrate anticoagulation of continuous renal replacement therapy. Blood Purif, 2012, 33(1/2/3): 80-87.
17.	Crowley KE, DeGrado JR, Charytan DM. Serum glucose and phosphorus concentrations during continuous renal replacement therapy using commercial replacement solutions with or without phosphorus. Hemodial Int, 2020, 24(3): 330-334.
18.	Cappoli A, Labbadia R, Antonucci L, et al. A simplified protocol of regional citrate anticoagulation with phosphate-containing solutions in infants and children treated with continuous kidney replacement therapy. Pediatr Nephrol, 2023, 38(11): 3835-3844.

1. Wu MY, Hsu YH, Bai CH, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a meta-analysis of randomized controlled trials. Am J Kidney Dis, 2012, 59(6): 810-818.
2. 共识专家组. 抗凝技术在危重症肾脏替代治疗应用的中国专家共识(2023 年版). 中华肾脏病杂志, 2023, 39(2): 155-164.
3. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
4. 中华医学会肾脏病学分会专家组. 连续性肾脏替代治疗的抗凝管理指南. 中华肾脏病杂志, 2022, 38(11): 1016-1024.
5. 崔庆宏, 孙峰, 刘树元, 等. 急诊连续性肾脏替代治疗中局部枸橼酸抗凝应用情况的调查研究. 中华危重病急救医学, 2020, 32(5): 595-600.
6. Xinping Z, Jie H, Zhenya Y, et al. Citrate anticoagulation in plasma exchange followed by continuous renal replacement therapy in critically ill children. Int J Artif Organs, 2024, 47(2): 85-95.
7. Poh CB, Tan PC, Kam JW, et al. Regional citrate anticoagulation for continuous renal replacement therapy - a safe and effective low-dose protocol. Nephrology (Carlton), 2020, 25(4): 305-313.
8. Israni A, Goldfarb DS. Let’s stop talking about ‘citrate toxicity’. Curr Opin Nephrol Hypertens, 2024, 33(2): 181-185.
9. Di Mario F, Sabatino A, Regolisti G, et al. Simplified regional citrate anticoagulation protocol for CVVH, CVVHDF and SLED focused on the prevention of KRT-related hypophosphatemia while optimizing acid-base balance. Nephrol Dial Transplant, 2023, 38(10): 2298-2309.
10. Liu SY, Xu SY, Yin L, et al. Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus. Mil Med Res, 2023, 10(1): 23.
11. Lenga I, Hopman WM, O’Connell AJ, et al. Flexitrate regional citrate anticoagulation in continuous venovenous hemodiafiltration: a retrospective analysis. BMC Nephrol, 2019, 20(1): 452.
12. Jeffrey YH, Hoi-Ping S, Kit Hung AL, et al. Experiences with continuous venovenous hemofiltration using 18 mmol/L predilution citrate anticoagulation and a phosphate containing replacement solution. Indian J Crit Care Med, 2017, 21(1): 11-16.
13. 胡新, 毛智, 李青霖, 等. 新型含枸橼酸无钙置换液在重症患者血液净化治疗中的抗凝效果. 解放军医学杂志, 2020, 45(12): 1259-1264.
14. 血液净化急诊临床应用专家共识组. 血液净化急诊临床应用专家共识. 中华急诊医学杂志, 2017, 26(1): 24-36.
15. Fiaccadori E, Sabatino A, Barazzoni R, et al. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr, 2021, 40(4): 1644-1668.
16. Balik M, Zakharchenko M, Otahal M, et al. Quantification of systemic delivery of substrates for intermediate metabolism during citrate anticoagulation of continuous renal replacement therapy. Blood Purif, 2012, 33(1/2/3): 80-87.
17. Crowley KE, DeGrado JR, Charytan DM. Serum glucose and phosphorus concentrations during continuous renal replacement therapy using commercial replacement solutions with or without phosphorus. Hemodial Int, 2020, 24(3): 330-334.
18. Cappoli A, Labbadia R, Antonucci L, et al. A simplified protocol of regional citrate anticoagulation with phosphate-containing solutions in infants and children treated with continuous kidney replacement therapy. Pediatr Nephrol, 2023, 38(11): 3835-3844.

West China Medical Journal

Latest ArticlesAdvances in the application of hemofiltration replacement fluid of sodium citrate in continuous renal replacement therapy

Abstract Full text Figures/Tables Video References Cited by

Format

Content