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Let's stop talking about 'citrate toxicity'.

Avantika Israni1, David S Goldfarb

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Current Opinion in Nephrology and Hypertension
|November 14, 2023
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Summary
This summary is machine-generated.

The term "citrate toxicity" is misleading for continuous renal replacement therapy (CRRT) anticoagulation. This review suggests replacing it with "citrate accumulation" to better reflect potential adverse effects like hypocalcemia.

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Continuous renal replacement therapy (CRRT) is essential for acute kidney injury (AKI) in critically ill patients.
  • Regional citrate anticoagulation is the preferred method to prevent extracorporeal circuit clotting during CRRT.
  • Concerns regarding 'citrate toxicity' often arise from perceived adverse effects of citrate accumulation.

Approach:

  • This review critically examines the existing literature on citrate metabolism and clearance.
  • It analyzes the mechanisms behind citrate's effects, particularly concerning acid-base balance and calcium levels.
  • The review aims to debunk the notion of inherent citrate toxicity by evaluating current data.

Key Points:

  • Citrate itself is not inherently toxic; adverse effects are linked to its accumulation and subsequent metabolic changes.
  • Hypocalcemia and metabolic alkalosis are potential consequences of citrate accumulation, not direct toxicity.
  • Current data suggesting metabolic acidosis from citrate accumulation is questioned, highlighting citrate's alkalinizing properties.

Conclusions:

  • The prevailing term 'citrate toxicity' is inaccurate and should be reconsidered.
  • A more precise term, 'citrate accumulation,' should be adopted to describe adverse events.
  • A nuanced understanding of citrate's safety profile in CRRT is crucial for appropriate clinical management.