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Citrate doubles CRRT filter lifespan: A real-world Chinese cohort study
Qing Ou1, Dan He1, Xiuying Shi1
1Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
The International Journal of Artificial Organs
|April 16, 2026
Summary
Citrate anticoagulation significantly extends filter survival time during continuous renal replacement therapy (CRRT), reducing clotting risk compared to heparin. Optimizing blood flow and tailoring anticoagulation for ventilated patients enhances CRRT efficacy.
Area of Science:
- Nephrology
- Critical Care Medicine
- Clinical Pharmacology
Background:
- Continuous renal replacement therapy (CRRT) is vital for acute kidney injury (AKI) and fluid overload in critically ill patients.
- Real-world data on CRRT application, anticoagulation, and efficacy in China is limited.
Purpose of the Study:
- To investigate CRRT practices and identify factors influencing filter survival in a Chinese tertiary hospital.
- To compare the efficacy of different anticoagulation strategies, particularly citrate versus heparin.
Main Methods:
- Retrospective cohort study of 238 CRRT sessions in an ICU.
- Data collected included patient demographics, severity scores, CRRT parameters, anticoagulation methods, and outcomes.
- Filter survival time was analyzed using Kaplan-Meier and Cox proportional hazards models.
Main Results:
- Citrate anticoagulation was associated with a significantly lower risk of filter clotting compared to heparin (HR=0.49).
- Higher blood flow rates (>150 mL/min) showed a protective effect against filter clotting (HR=0.65).
- Mechanical ventilation increased the risk of filter clotting (HR=2.15); median filter survival was 38.5h for citrate, 18.0h for heparin, and 26.0h for nafamostat.
Conclusions:
- Citrate anticoagulation is linked to extended filter lifespan in CRRT, suggesting it as a preferred strategy.
- Optimizing blood flow and individualized anticoagulation for mechanically ventilated patients can improve CRRT effectiveness.
- Findings provide valuable real-world evidence for clinical decision-making in CRRT management.
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