{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:14:24Z","timestamp":1792782864948,"version":"4.5.0"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Istanbul Medeniyet University","id":[{"id":"https:\/\/ror.org\/05j1qpr59","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Nephrol"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Regional citrate anticoagulation (RCA) is the preferred strategy for continuous kidney replacement therapy in children; however, the optimal post-filter ionized calcium target remains uncertain. Lower targets may increase anticoagulation but raise citrate exposure and metabolic complications. We aimed to compare anticoagulation efficacy and metabolic safety between a low-target (0.25\u20130.35\u00a0mmol\/L) and a high-target (0.30\u20130.40\u00a0mmol\/L) post-filter ionized calcium protocol in critically ill children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study included critically ill children receiving continuous veno-venous hemodiafiltration with citrate as the pre-filter anticoagulation solution at a tertiary pediatric intensive care unit over a 4-year period. A total of 87 patients (42 low-target, 45 high-target) and 154 circuits (71 versus 83) were analyzed. The primary outcome was circuit survival (CS). Secondary outcomes included citrate dose, citrate load, and RCA-related complications. Continuous variables were analyzed using the Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test, and CS was assessed with Cox regression. Linear mixed models evaluated citrate changes, and generalized estimating equations analyzed metabolic outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median CS was comparable between groups (49 versus 48\u00a0h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.76) as was the survival of clotted circuits (41 versus 40\u00a0h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.70) and circuit clotting rates were similar (21.1% versus 24.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.70). The low-target group had higher median citrate dose (2.9 versus 2.6\u00a0mmol\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), citrate load (0.76 versus 0.72\u00a0mmol\/kg\/h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), and more frequent hypocalcemia (17.5% versus 12.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), metabolic alkalosis (31.9% versus 22.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and citrate accumulation (24.5% versus 15.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Linear mixed models showed a persistently higher citrate dose and citrate load in the low-target group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Generalized estimating equations demonstrated increased odds of hypocalcemia (odds ratio 1.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and citrate accumulation (odds ratio 1.93,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the low-target group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Raising the target of post-filter ionized calcium from 0.25\u20130.35 to 0.30\u20130.40\u00a0mmol\/L reduced citrate exposure and metabolic complications without compromising CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Retrospectively registered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-026-07440-1","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:57Z","timestamp":1783509357000},"page":"4547-4559","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of post-filter ionized calcium target range on circuit survival and citrate-related complications in pediatric continuous kidney replacement therapy"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7892-2927","authenticated-orcid":false,"given":"Muhterem","family":"Duyu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0973-8098","authenticated-orcid":false,"given":"Ay\u015fe","family":"A\u015f\u0131k","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"7440_CR1","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1093\/ndt\/gfab280","volume":"37","author":"I Guzzo","year":"2022","unstructured":"Guzzo I, de Galasso L, Bayazit AK et al (2022) Acute paediatric kidney replacement therapies in Europe: demographic results from the EurAKId Registry. 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