Table 1.

Characteristics of the main regional citrate anticoagulation protocols

Citrate Solution/RRT ModalityBlood Flow and Citrate Infusion RatesCitrate SolutionDialysateReplacement FluidReference
High concentration (hypertonic in sodium)
 Postdilution CVVHQb=150–300 ml/min; citrate=38–77 ml/h (38–77 mmol/h)TSC=1000 mmol/L; Na+=3000 mmol/LN/ALow sodium (120 mmol/L); buffer-free; calcium-freeMonchi et al. (15)
 Predilution CVVHDFQb=150 ml/min; citrate 150 ml/h (16.9 mmol/h)ACD-A: citrate=112.9 mmol/L (TSC=2.2%/citric acid=0.8%); Na+=224 mmol/LLow sodium (132 mmol/L); lactate=40 mmol/L; calcium containing (1.25 mmol/L)Isotonic saline (Na+=154 mmol/L)Gupta et al. (103)
 Postdilution CVVHDFQb=125 ml/min; citrate=190 ml/h (25.3 mmol/h)TSC=133 mmol/L; Na+=399 mmol/LLow sodium (117 mmol/L); buffer-free; calcium-freeLow sodium (117 mmol/L); variable bicarbonate (33–50 mmol/L according to A-B status); calcium-freeKutsogiannis et al. (16)
 Postdilution CVVHQb=220 ml/min; citrate flow rate not reported (target citratemia=3 mmol/L)TSC/citric acid=500 mmol/L; Na+=1352 mmol/LN/ALow sodium (109.5 mmol/L); buffer-free combined with a bicarbonate-buffered solution according to A-B status; Ca2+=1.81 mmol/LOudemans-van Straaten et al. (18)
 CVVHDQb=80–120 ml/min; citrate=140–205 ml/h (19–27.9 mmol/h)TSC=136 mmol/L; Na+=408 mmol/LLow sodium (133 mmol/L); low bicarbonate (20 mmol/L); calcium-freeN/AMorgera et al. (46)
 CVVHDQb=150–200 ml/min; citrate flow rate not reported (target citratemia=4 mmol/L)TSC=136 mmol/L; Na+=408 mmol/LLow sodium (133 mmol/L); low bicarbonate (20 mmol/L); calcium-freeN/AKalb et al. (49)
 Predilution CVVHDFQb=120 ml/min; citrate=700 ml/h (19.75 mmol/h)ACD-A–based diluted citrate solution=28.22 mmol/L; Na+=163.3 mmol/L; bicarbonate=30 mmol/LLow sodium (133 mmol/L); low bicarbonate (20 mmol/L); calcium-freeN/AMariano et al. (47)
 CVVHDQb=75–100 ml/min; citrate=35–45 ml/h (39.3–50.6 mmol/h)TSC/citric acid=743/381 mmol/L; Na+=2229 mmol/LLow to standard sodium (129–140 mmol/L); variable bicarbonate (13.2–34.3 mmol/L according to A-B status); calcium containing (1.75 mmol/L)N/ASaner et al. (57)
 SLEDQb 200 ml/min; citrate 180 ml/h (24.5 mmol/h)TSC=136 mmol/L; Na+=408 mmol/LStandard dialysate (Genius system; 180–200 ml/min); calcium containing (1.0 mmol/L)N/AMorgera et al. (105)
 SLEDQb=250 ml/min; citrate=231–261 ml/h (31.4–35.5 mmol/h)TSC=136 mmol/L; Na+=408 mmol/LStandard sodium and bicarbonate dialysate (300 ml/min); calcium-freeN/AClark et al. (86)
 SLED-HDFQb=130 ml/min; citrate=1350 ml/h (38.1 mmol/h)ACD-A–based diluted citrate solution=28.22 mmol/L; Na+=163.3 mmol/L; bicarbonate=30 mmol/LLow sodium (133 mmol/L); low bicarbonate (20 mmol/L); calcium-freeN/AMariano et al. (47)
 SLEDQb=200 ml/min; citrate=200–400 ml/h (22.6–45.2 mmol/h)ACD-A: citrate=112.9 mmol/L (TSC=2.2%/citric acid=0.8%); Na+=224 mmol/LCocurrent flow standard dialysate (300 ml/min); calcium containing (1.25 mmol/L)N/AFiaccadori et al. (51)
Low concentration (isotonic in sodium)
 Predilution CVVHDFQb=100–150 ml/min; citrate=1000–2000 ml/h (18–46 mmol/h)TSC=18 or 23 mmol/L obtained by diluting a TSC 4% citrate solution; Na+=140 mmol/LStandard sodium (140 mmol/L); low bicarbonate (25 mmol/L); calcium-freeN/ATolwani et al. (62)
 Predilution CVVHQb=100–200 ml/min; citrate=2000–4000 ml/h (26–52 mmol/h)TSC=13 mmol/L; Na+=140 mmol/LN/AN/AHetzel et al. (19)
 Pre- and postdilution CVVHQb=130–150 ml/min; citrate=1560–1800 ml/h (18.7–21.6 mmol/h)TSC/citric acid=10/2 mmol/L; Na+=136 mmol/LN/AStandard sodium (140 mmol/L); standard bicarbonate (32 mmol/L); calcium containing (1.75 mmol/L)Morabito et al. (14)
 Predilution CVVHQb=150 ml/min; citrate=2500 ml/h (30 mmol/h)TSC/citric acid=10/2 mmol/L; Na+=136 mmol/LN/AN/AShum et al. (64)
 Predilution CVVHQb=180 ml/min; citrate=2400 ml/h (31.9 mmol/h)TSC=13.3 mmol/L; Na+=140 mmol/LN/AN/ANurmohamed et al. (50)
 Pre- and postdilution CVVHDFQb=140 ml/min; citrate=1000 ml/h (18 mmol/h)TSC=18 mmol/L; Na+=140 mmol/LStandard sodium (140 mmol/L); standard bicarbonate (30 mmol/L); calcium containing (1.25 mmol/L); phosphate containing (HPO42+=1.2 mmol/L)Standard sodium (140 mmol/L); standard bicarbonate (30 mmol/L); calcium containing (1.25 mmol/L); phosphate containing (HPO42−=1.2 mmol/L)Morabito et al. (66)
  • The definitions SLED and SLED-HDF have been maintained as in the original articles; both treatment modalities may be included under the term prolonged intermittent RRT (PIRRT). CVVH, continuous venovenous hemofiltration; CVVHDF, continuous venovenous hemodiafiltration; CVVHD, continuous venovenous hemodialysis; SLED, sustained low-efficiency dialysis; SLED-HDF, sustained low-efficiency hemodiafiltration; Qb, blood flow rate; TSC, trisodium citrate; ACD-A, anticoagulant citrate dextrose solution A; N/A, not applicable.