{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:54:53Z","timestamp":1790250893595,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Regional citrate anticoagulation (RCA) is the preferred strategy for continuous renal replacement therapy (CRRT). However, impaired citrate metabolism, observed in patients with liver failure, mitochondrial dysfunction, and\/or shock, can result in potentially lethal citrate accumulation (CA). We aimed to evaluate the ability of elevated lactate levels to predict CA in critically ill patients undergoing RCA\u2010CRRT. We performed a comprehensive search in\n                    <jats:styled-content style=\"fixed-case\">PubMed<\/jats:styled-content>\n                    and Embase databases for studies involving adult critically ill patients who underwent\n                    <jats:styled-content style=\"fixed-case\">RCA<\/jats:styled-content>\n                    \u2010\n                    <jats:styled-content style=\"fixed-case\">CRRT<\/jats:styled-content>\n                    , where both\n                    <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>\n                    and lactate levels were assessed. The primary outcome was lactate levels in relation to patients with and without\n                    <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>\n                    . The certainty of the effect estimates for each outcome and the quality of the included studies were assessed. We included seven observational studies comprising 1573 critically ill patients undergoing RCA\u2010CRRT. Five studies were deemed good quality evidence and two poor to answer the research question. We found a significant mean difference (MD) in baseline lactate levels (MD: 0.87, 95% CI [0.04; 1.70]\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04, six studies, 1474 patients) between the CA and the non\u2010CA group with low confidence in the estimate. This difference was persistent between the two groups when using peak lactate levels (MD: 6.05, 95% CI [0.06; 12.03],\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.05, three studies, 271 patients), and the CA group had an overall higher mortality risk (OR: 5.24, 95% CI [1.05; 26.25],\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04, five studies, 1427 patients). The evidence is very uncertain, but elevated lactate may be associated with an increased risk of CA in critically ill patients undergoing RCA\u2010CRRT.\n                  <\/jats:p>","DOI":"10.1111\/aas.70060","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T09:50:59Z","timestamp":1747648259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Lactate as a Predictor of Citrate Accumulation in Patients Undergoing Continuous Renal Replacement Therapy? A Systematic Review"],"prefix":"10.1111","volume":"69","author":[{"given":"Johan U.","family":"Ulrichsen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Copenhagen University Hospital \u2013 Hvidovre  Hvidovre Denmark"},{"name":"Centre for Physical Activity Research (CFAS) Copenhagen University Hospital \u2013 Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronni R.","family":"Plovsing","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Copenhagen University Hospital \u2013 Hvidovre  Hvidovre Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolai B.","family":"Foss","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Copenhagen University Hospital \u2013 Hvidovre  Hvidovre Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-9506","authenticated-orcid":false,"given":"Ronan M. G.","family":"Berg","sequence":"additional","affiliation":[{"name":"Centre for Physical Activity Research (CFAS) Copenhagen University Hospital \u2013 Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Clinical Physiology and Nuclear Medicine Copenhagen University Hospital \u2010 Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8140-2583","authenticated-orcid":false,"given":"Ulrik W.","family":"Iepsen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Copenhagen University Hospital \u2013 Hvidovre  Hvidovre Denmark"},{"name":"Centre for Physical Activity Research (CFAS) Copenhagen University Hospital \u2013 Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11010172"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.23876\/j.krcp.21.043"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04350422"},{"key":"e_1_2_13_5_1","first-page":"1","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury","volume":"2","author":"Kellum J. A.","year":"2012","journal-title":"Kidney International Supplements (2011)"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0754-4"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-4099-0"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.18618"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000529076"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.11.030"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1299-0"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000046075"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000334641"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1880-1"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s44158-023-00091-w"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-0648-y"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1113\/EP089474"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2018.03.008"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-014-0503-3"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2013.10.015"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002501"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc11485"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066617701068"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc11645"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1159\/000513947"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.05.005"},{"key":"e_1_2_13_27_1","first-page":"695","article-title":"Ionic Homeostasis, Acid\u2010Base Balance and the Risk of Citrate Accumulation in Patients After Cardiovascular Surgery Treated With Continuous Veno\u2010Venous Haemofiltration With Post\u2010Dilution Regional Citrate Anticoagulation \u2013 An Observational Case\u2010Control Study","volume":"68","author":"Ko\u015bka A.","year":"2021","journal-title":"Acta Biochimica Polonica"},{"key":"e_1_2_13_28_1","doi-asserted-by":"crossref","unstructured":"S. A.Nurmohamed B. P.Jallah M. G.Vervloet G.Yldirim P. M.Ter Wee andA. J.Groeneveld \u201cContinuous venovenous haemofiltration with citrate\u2010buffered replacement solution is safe and efficacious in patients with a bleeding tendency: a prospective observational study [Internet] \u201d2013 http:\/\/www.biomedcentral.com\/1471\u20102369\/14\/89.","DOI":"10.1186\/1471-2369-14-89"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac223"},{"key":"e_1_2_13_30_1","unstructured":"G. A.Wells B.Shea D.O'Connell J.Peterson V.Welch andM.Losos \u201cThe Newcastle\u2010Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses \u201d2011."},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-019-2317-9"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.201802056R"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc9358"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1152\/physiol.00033.2017"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002255"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1403-5"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4002"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7125.140"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.70060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T11:34:12Z","timestamp":1750937652000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.70060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/aas.70060"],"URL":"https:\/\/doi.org\/10.1111\/aas.70060","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]},"assertion":[{"value":"2025-04-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70060"}}