Table 3.

Monitoring of regional citrate anticoagulation for continuous RRT

ParameterMonitoring IntervalsAim
Circuit ionized calcium (postfilter)Within 1 h from the start of the treatment and then at least every 6–8 hTo evaluate the maintenance of circuit ionized calcium within the intended target and modify citrate dose accordingly
Systemic ionized calciumBaseline (before starting RRT)To check baseline levels and set initial calcium infusion rate
Within 1 h from the start of the treatment and then at least every 4–6 hTo evaluate the maintenance of systemic ionized calcium within the physiologic range and modulate calcium infusion rate accordingly
Systemic total calciumAt least every 12–24 h (simultaneous to systemic ionized calcium)To calculate calcium ratio (total-to-ionized systemic calcium) as an indirect index of citrate accumulation (≥2.5)
Acid-base parameters (pH and bicarbonate)aBaseline (before starting RRT)To exclude acid-base imbalances (metabolic acidosis or alkalosis) and modify RCA and RRT parameters setting if needed
Within 1 h from the start of the treatment and then at least every 4–6 h
MagnesiumAt least every 24 hTo modulate the amount of magnesium supplementation if needed
Serum sodiumOnce dailyTo exclude hypernatremia or hyponatremia (rarely observed with a correct matching of RCA solutions)
Citratemia (if available)Not routinely used for clinical purposesTo confirm hypercitratemia in the presence of indirect signs of citrate accumulation
Serum lactateBaseline (before starting RRT)To identify patients at higher risk for citrate accumulation and monitor lactate levels during RCA
At least every 6–12 h or according to clinical needs
  • a Sample drawn from an arterial line.