Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution

Blood Purif. 2016;42(4):349-355. doi: 10.1159/000452755. Epub 2016 Nov 19.


Background/aims: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective.

Methods: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin.

Results: We present the first 29 patients who used 98 filters. After excluding 'non-clot' filter loss, 50% had a duration of >27 h. Calcium supplementation was required for 30 (30%) filter circuits, in 17 of 29 (58%) patients. One patient discontinued the treatment due to metabolic alkalosis, but there were no adverse bleeding events.

Conclusion: Post-dilution RCA system is effective and simple to use on the Aquarius platform and results in comparable filter life for patients relatively contraindicated to heparin.

MeSH terms

  • Anticoagulants / administration & dosage*
  • Bicarbonates* / chemistry
  • Buffers*
  • Citric Acid / administration & dosage*
  • Dialysis Solutions* / administration & dosage
  • Dialysis Solutions* / chemistry
  • Electrolytes / chemistry
  • Female
  • Hemofiltration* / methods
  • Humans
  • Male
  • Treatment Outcome


  • Anticoagulants
  • Bicarbonates
  • Buffers
  • Dialysis Solutions
  • Electrolytes
  • Citric Acid