Efficacy and safety of a novel 18 mmol/L sodium citrate hemofiltration solution in continuous renal replacement therapy for critically ill patients: a retrospective cohort study.

BACKGROUND: Continuous renal replacement therapy (CRRT) serves as a cornerstone of supportive care for critically ill patients. The selection of anticoagulation strategies and hemofiltration solutions is pivotal to the safety and efficacy of CRRT. Regional citrate anticoagulation (RCA) has been widely adopted in CRRT practice; however, it is associated with cumbersome operational procedures. Furthermore, traditional high-concentration sodium citrate anticoagulants are associated with an increased risk of metabolic complications. This study compared a novel 18 mmol/L sodium citrate hemofiltration solution with the traditional RCA protocol, with the aim of evaluating the safety, efficacy, and clinical convenience of the novel solution in CRRT for critically ill patients.

METHODS: This retrospective cohort study was conducted on 105 CRRT sessions in the intensive care unit (ICU) of Beijing Electric Power Hospital between July 1 and September 30, 2025. Inclusion criteria were age ≥18 years and use of CRRT with regional citrate anticoagulation (RCA). Exclusion criteria were contraindications to citrate anticoagulation, psychiatric illness, or pregnancy/lactation. Patients were divided into two groups based on the anticoagulation method: sodium citrate hemofiltration solution group (n=53) and traditional regional citrate anticoagulation (tRCA) group (n=52). We collected and compared baseline characteristics, CRRT treatment parameters, post-filter ionized calcium levels, complication rates, and workflow parameters between the two groups.

RESULTS: No significant differences were observed between the two groups in terms of gender distribution, comorbidities or disease severity indicators, including Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The sodium citrate hemofiltration solution group demonstrated a significantly longer mean CRRT duration compared to the tRCA group (50.91±13.07 vs. 45.19±10.83 hours; P=0.02). Multivariable Cox regression analysis was performed to adjust for potential confounders; the use of sodium citrate hemofiltration solution remained independently associated with significantly longer filter survival compared with tRCA [adjusted hazard ratio (HR) =0.615, 95% confidence interval (CI): 0.404-0.935, P=0.02]. Post-filter ionized calcium concentrations remained within target ranges (0.2-0.4 mmol/L) across all time points in both groups. The sodium citrate hemofiltration solution group showed lower incidences of citrate accumulation (0% vs. 7.7%, P=0.04) and metabolic alkalosis (3.8% vs.17.3%, P=0.02). The study group showed a higher rate of hypomagnesemia than the tRCA group (9.4% vs. 0%, P=0.02). The sodium citrate hemofiltration solution group required fewer infusion and syringe pumps {2 [interquartile range (IQR), 2-2] vs. 3 (IQR, 3-3), P<0.001} and had a lower hourly bag-change frequency [0.57 (IQR, 0.51-0.59) vs. 1.17 (IQR, 1.15-1.19) bags/hour, P<0.001] compared with the tRCA group.

CONCLUSIONS: Sodium citrate hemofiltration replacement solution enables effective anticoagulation, prolongs filter lifespan, reduces metabolic complications, and simplifies clinical procedures in critically ill patients undergoing CRRT. These findings support the potential utility of sodium citrate hemofiltration solution in the ICU, though confirmation in prospective trials is warranted.