Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium-Containing Solutions: A Randomized Controlled Trial

Semin Dial. 2024 May-Jun;37(3):249-258. doi: 10.1111/sdi.13200. Epub 2024 Mar 5.


Background: Calcium-free (Ca-free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium-containing (Ca-containing) solutions instead of Ca-free ones due to their scarcity. This study was designed to probe into the potential of Ca-containing solution as a secure and efficient substitution for Ca-free solutions.

Methods: In this prospective, randomized single-center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno-venous hemodialysis Ca-free dialysate (CVVHD Ca-free) group, continuous veno-venous hemodiafiltration calcium-free dialysate (CVVHDF Ca-free) group, and continuous veno-venous hemodiafiltration Ca-containing dialysate (CVVHDF Ca-containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process.

Results: The incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all).

Conclusions: In RCA-CRRT for CICU population, RCA-CVVHDF with Ca-containing solutions and traditional RCA with Ca-free solutions had a comparable safety and feasibility.

Trial registration: ChiCTR2100048238 in the Chinese Clinical Trial Registry.

Keywords: calcium‐containing solutions; continuous renal replacement therapy; metabolic complications; regional citrate anticoagulation; thrombus.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / therapy
  • Aged
  • Anticoagulants* / administration & dosage
  • Calcium / administration & dosage
  • Calcium / blood
  • China
  • Citric Acid* / administration & dosage
  • Continuous Renal Replacement Therapy* / methods
  • Dialysis Solutions* / administration & dosage
  • Dialysis Solutions* / chemistry
  • Feasibility Studies*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies


  • Anticoagulants
  • Citric Acid
  • Dialysis Solutions
  • Calcium