Citrate accumulation during regional citrate anticoagulation for continuous renal replacement therapy: a narrative review.

Regional citrate anticoagulation (RCA) has been increasingly adopted as a preferred anticoagulation strategy in continuous renal replacement therapy (CRRT). However, Citrate accumulation during RCA-CRRT represents a major clinical challenge. This review provides an overview of the mechanisms underlying citrate accumulation, its diagnostic criteria, and the primary factors contributing to citrate accumulation, including excessive citrate infusion dose, insufficient citrate loss across the filter, impairment of citrate metabolism. In addition, the clinical consequences of citrate accumulation and current management strategies are summarized, aiming to provide insights for optimizing the safety and efficacy of RCA-CRRT.