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Citrate: How to Get Started and What, When, and How to Monitor?

Patrick M Honore1, David De Bels1, Thierry Preseau2

  • 1ICU Department, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.

Journal of Translational Internal Medicine
|November 15, 2018
PubMed

Insights

Regional citrate anticoagulation uses diluted citrate for safety. Highly concentrated citrate serves as a bactericidal agent and anticoagulant for hemodialysis catheters, offering bedside benefits in renal replacement therapy.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Regional citrate anticoagulation (RCA) commonly employs diluted citrate solutions (approx. 1%).
  • Highly concentrated citrate (4% or higher) presents increased risks.
  • Trisodium citrate at high concentrations (25-30%) has dual roles in hemodialysis.

Purpose of the Study:

  • To review the buffer and anticoagulant properties of citrate during renal replacement therapy.
  • To focus on the practical bedside application of citrate in critically ill patients.

Main Methods:

  • Literature review of citrate use in renal replacement therapy.
  • Analysis of citrate concentrations and applications in clinical practice.

Main Results:

  • Diluted citrate (around 1%) is generally safer for anticoagulation.
  • High-concentration trisodium citrate (25-30%) functions as both an anticoagulant and a bactericidal agent for catheter locks.
  • Citrate offers buffering capacity relevant to renal replacement therapy.

Conclusions:

  • Citrate management in renal replacement therapy requires careful consideration of concentration and application.
  • Understanding citrate's dual properties is crucial for safe and effective bedside use in critically ill patients.

Keywords:
diluted citratemetabolic complicationsmonitoringregional citrate anticoagulation

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