{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:15:14Z","timestamp":1773382514544,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ther Apher Dial"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Regional citrate anticoagulation (RCA) is increasingly utilized for therapeutic plasma exchange (TPE). Currently, many clinical studies have focused on the safety and efficacy of RCA in TPE. However, due to the complex application and the lack of a uniform standard of RCA, the results of these researches, especially citrate\u2010related metabolic complications, varied greatly in different studies. The purpose of this meta\u2010analysis is to assess the safety and efficacy of RCA in TPE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a comprehensive search on PubMed, Embase, and the Cochrane Library database from the inception to August 26, 2024. Studies regarding the application of RCA in TPE were included to assess the efficacy and safety of RCA in TPE. The methodological quality of the included studies was assessed using the Newcastle\u2010Ottawa Scale and the Jadad scale. Meta\u2010analysis was performed using Stata software (version 15.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 13 eligible studies included, involving 4268 RCA\u2013TPE sessions. The pooled rate of extracorporeal circuit clotting, bleeding, citrate accumulation, hypocalcemia, hypernatremia, hypomagnesemia, and metabolic alkalosis was 5.3% (95% CI [2.4\u20139.2]), 2.0% (95% CI [0.2\u20135.0]), 1.8% (95% CI [0.0\u20136.7]), 17.9% (95% CI [2.3\u201342.5]), 1.7% (95% CI [0.0\u20135.1]), 45.6% (95% CI [25.9\u201366.0]), and 14.8% (95% CI [0.5\u201341.3]), respectively. Subgroup analysis of hypocalcemia and metabolic alkalosis in the membrane therapeutic plasma exchange (mTPE) was 42.1% (95% CI [2.5\u201389.7]) and 32.4% (95% CI [25.3\u201339.9]), respectively. Compared to before treatment, the serum sodium and bicarbonate significantly increased, and serum calcium decreased significantly after RCA\u2013TPE treatment. There was no difference in platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), the ratio of total calcium to ionized calcium, total calcium, pH, and base excess (BE) before and after treatment. Subgroup analyses demonstrated that pH and BE in mTPE, and APTT and PT in double filtration plasmapheresis (DFPP) were significantly increased after treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Regional citrate anticoagulation might be effective in TPE treatments. However, the incidence of hypomagnesemia, hypocalcemia, and metabolic alkalosis is relatively high. Close monitoring and timely adjustment are needed during the process of RCA\u2013TPE treatment to avoid these complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1744-9987.70106","type":"journal-article","created":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T07:15:24Z","timestamp":1766214924000},"page":"188-202","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Safety and Efficacy of Regional Citrate Anticoagulation in Therapeutic Plasma Exchange: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6868-2625","authenticated-orcid":false,"given":"Tong","family":"Liu","sequence":"first","affiliation":[{"name":"The Department of Nephrology Xijing Hospital, The Fourth Military Medical University  Xi'an Shaanxi 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