{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:11:49Z","timestamp":1793293909048,"version":"4.5.0"},"reference-count":61,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Anticoagulation is recommended to maintain the patency of the circuit in continuous renal replacement therapy (CRRT). However, anticoagulation-associated complications can occur. We performed a systematic review and meta-analysis to compare the efficacy and safety of citrate anticoagulation to heparin anticoagulation in critically ill patients treated with CRRT. Methods: Randomised controlled trials (RCTs) evaluating the safety and efficacy of citrate anticoagulation and heparin in CRRT were included. Articles not describing the incidence of metabolic and\/or electrolyte disturbances induced by the anticoagulation strategy were excluded. The PubMed, Embase, and MEDLINE electronic databases were searched. The last search was performed on 18 February 2022. Results: Twelve articles comprising 1592 patients met the inclusion criteria. There was no significant difference between the groups in the development of metabolic alkalosis (RR = 1.46; (95% CI (0.52\u20134.11); p = 0.470)) or metabolic acidosis (RR = 1.71, (95% CI (0.99\u20132.93); p = 0.054)). Patients in the citrate group developed hypocalcaemia more frequently (RR = 3.81; 95% CI (1.67\u20138.66); p = 0.001). Bleeding complications in patients randomised to the citrate group were significantly lower than those in the heparin group (RR 0.32 (95% CI (0.22\u20130.47); p &lt; 0.0001)). Citrate showed a significantly longer filter lifespan of 14.52 h (95% CI (7.22\u201321.83); p &lt; 0.0001), compared to heparin. There was no significant difference between the groups for 28-day mortality (RR = 1.08 (95% CI (0.89\u20131.31); p = 0.424) or 90-day mortality (RR 0.9 (95% CI (0.8\u20131.02); p = 0.110). Conclusion: regional citrate anticoagulation is a safe anticoagulant for critically ill patients who require CRRT, as no significant differences were found in metabolic complications between the groups. Additionally, citrate has a lower risk of bleeding and circuit loss than heparin.<\/jats:p>","DOI":"10.3390\/life13051198","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T06:00:29Z","timestamp":1684389629000},"page":"1198","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy: Is Metabolic Fear the Enemy of Logic? A Systematic Review and Meta-Analysis of Randomised Controlled Trials"],"prefix":"10.3390","volume":"13","author":[{"given":"Rita","family":"Jacobs","sequence":"first","affiliation":[{"name":"Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Verbrugghe","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolien","family":"Dams","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Roelant","sequence":"additional","affiliation":[{"name":"Clinical Trial Center (CTC), Antwerp University Hospital, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0324-2171","authenticated-orcid":false,"given":"Marie Madeleine","family":"Couttenye","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Antwerp University Hospital, 2650 Edegem, Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics (LEMP), 2000 Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6083-2998","authenticated-orcid":false,"given":"Dirk","family":"Devroey","sequence":"additional","affiliation":[{"name":"Deparmtment of Family Medicine and Chronic Care, Faculty of Medicine and Framacy, Vrije Universiteit Brussels (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5434-957X","authenticated-orcid":false,"given":"Philippe","family":"Jorens","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics (LEMP), 2000 Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1097\/01.CCM.0B013E3181611F552","article-title":"Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: A meta-analysis","volume":"36","author":"Bagshaw","year":"2008","journal-title":"Crit. 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