{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:45:07Z","timestamp":1793832307408,"version":"4.6.1"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Regional citrate anticoagulation (RCA) is the recommended first-line strategy for continuous renal replacement therapy (CRRT), yet global implementation remains inconsistent. We reviewed our extensive single-center experience to provide a real-life evaluation of RCA feasibility, limitations, and environmental sustainability. Methods: We retrospectively analyzed RCA treatments performed in our center from 2012 to 2022. Technical performance was assessed by circuit patency and failure timing. Environmental impact was evaluated by simulating filter consumption and hazardous waste production compared to a projected strategy using unfractionated heparin (UFH). Results: RCA utilization grew progressively, reaching 98% of all treatments. The technique showed an 80.2% success rate and a robust safety profile, demonstrating excellent feasibility and efficacy in clinical practice. However, among circuits intended for 72 h survival, over one-third failed prematurely; segmented regression confirmed a critical high-risk period within the first 24 h, with a significantly higher rate of circuit loss compared to the subsequent period (p &lt; 0.05). In our simulation, RCA adoption saved over 1000 filters, preventing the emission of approximately 12 tons of CO2 equivalent. Conclusions: RCA is a safe, effective, and environmentally appealing method of CRRT. However, significant room for improvement remains; refining the technique to increase circuit success rates is essential to optimize clinical efficiency and further minimize the ecological footprint of acute renal care.<\/jats:p>","DOI":"10.3390\/jcm15051807","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T11:22:57Z","timestamp":1772191377000},"page":"1807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Regional Citrate Anticoagulation in CRRT: Successes, Pitfalls, and Sustainability from a Long-Term Single-Center Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-5737","authenticated-orcid":false,"given":"Emanuele","family":"De Simone","sequence":"first","affiliation":[{"name":"Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d\u2019Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, 10154 Turin, Italy"},{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Guarino","sequence":"additional","affiliation":[{"name":"Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d\u2019Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, 10154 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Pozzato","sequence":"additional","affiliation":[{"name":"Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d\u2019Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, 10154 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4419-6813","authenticated-orcid":false,"given":"Dario","family":"Roccatello","sequence":"additional","affiliation":[{"name":"Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d\u2019Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, 10154 Turin, Italy"},{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1266-9441","authenticated-orcid":false,"given":"Savino","family":"Sciascia","sequence":"additional","affiliation":[{"name":"Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d\u2019Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, 10154 Turin, Italy"},{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8019-5749","authenticated-orcid":false,"given":"Roberta","family":"Fenoglio","sequence":"additional","affiliation":[{"name":"Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d\u2019Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, 10154 Turin, Italy"},{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"KDIGO (2012). KDIGO clinical practice guideline for acute kidney injury. Kidney Int. Suppl., 120, c179\u2013c184.","DOI":"10.1159\/000339789"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1001\/jama.2020.18618","article-title":"Effect of regional citrate anticoagulation versus systemic heparin anticoagulation on filter life: The RICH randomized clinical trial","volume":"324","author":"Zarbock","year":"2020","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s13054-015-0822-z","article-title":"Efficacy and safety of citrate anticoagulation in continuous renal replacement therapy: A randomized controlled trial","volume":"19","author":"Stucker","year":"2015","journal-title":"Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/MNH.0000000000001138","article-title":"Evolution of Continuous Renal Replacement Therapy Scenarios and the Rise of Anticoagulant-Free Continuous Veno-Venous Hemodiafiltration","volume":"35","author":"Dai","year":"2025","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_5","first-page":"iii1","article-title":"It is time for \u201cgreen\u201d renal care","volume":"27","author":"Agar","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_6","unstructured":"Baxter International Inc. (2021). Life Cycle Assessment of Continuous Renal Replacement Therapy with the Prismaflex System, Baxter Healthcare Corporation. Available online: https:\/\/shcoalition.org\/wp-content\/uploads\/2019\/10\/CRRT-with-Prismaflex.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s13054-023-04519-1","article-title":"Anticoagulation Options for Continuous Renal Replacement Therapy in Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials","volume":"27","author":"Zhou","year":"2023","journal-title":"Crit. Care"},{"key":"ref_8","first-page":"1345","article-title":"Regional citrate anticoagulation in critically ill patients: An update on clinical practice","volume":"35","author":"Villa","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1007\/s40620-025-02255-z","article-title":"Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy: A Prospective Study in a Resource-Limited Intensive Care Unit From Vietnam","volume":"38","author":"Huynh","year":"2025","journal-title":"J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1097\/CCM.0000000000001004","article-title":"Citrate versus heparin anticoagulation for continuous renal replacement therapy (CHEST Trial): A randomized controlled trial","volume":"43","author":"Gattas","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2098","DOI":"10.1007\/s00134-015-4099-0","article-title":"Citrate versus heparin anticoagulation for continuous renal replacement therapy: An updated meta-analysis of RCTs","volume":"41","author":"Bai","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1053\/j.ajkd.2011.11.030","article-title":"Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: A meta-analysis of randomized controlled trials","volume":"59","author":"Wu","year":"2012","journal-title":"Am. J. Kidney Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13054-016-1299-0","article-title":"Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: A meta-analysis of randomized controlled trials","volume":"20","author":"Liu","year":"2016","journal-title":"Crit. Care"},{"key":"ref_14","first-page":"CD012467","article-title":"Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy","volume":"12","author":"Tsujimoto","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1007\/s12325-025-03186-8","article-title":"Regional Citrate Anticoagulation Versus Systemic Heparin in Continuous Kidney Replacement Therapy: Examining the Role of Evidence in Health Technology Assessment","volume":"42","author":"Rognoni","year":"2025","journal-title":"Adv. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jcrc.2013.10.015","article-title":"Incidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation","volume":"29","author":"Khadzhynov","year":"2014","journal-title":"J. Crit. Care"},{"key":"ref_17","first-page":"450","article-title":"Regional citrate anticoagulation for continuous renal replacement therapy","volume":"24","author":"Brandenburger","year":"2018","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"8636","DOI":"10.1038\/s41598-025-87624-1","article-title":"Metformin-associated lactic acidosis and acute kidney injury","volume":"15","author":"Pozzato","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_19","first-page":"154330","article-title":"Impact of increasing post-filter ionized calcium target on filter lifespan in renal replacement therapy with regional citrate anticoagulation: A before-and-after study","volume":"77","author":"Assefi","year":"2023","journal-title":"J. Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1093\/ndt\/gfv031","article-title":"Eco-dialysis: The financial and ecological costs of dialysis waste products\u2014Is a \u201ccradle-to-cradle\u201d model feasible for planet-friendly haemodialysis waste management?","volume":"30","author":"Piccoli","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"sfae407","DOI":"10.1093\/ckj\/sfae407","article-title":"How to improve the environmental impact in haemodialysis: Small actions, big changes","volume":"18","author":"Portillo","year":"2025","journal-title":"Clin. Kidney J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"104229","DOI":"10.1016\/j.transci.2025.104229","article-title":"Citrate, a green alternative to heparin","volume":"64","author":"Griveas","year":"2025","journal-title":"Transfus. Apher. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1807\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T11:31:22Z","timestamp":1772191882000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051807"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051807","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}