Systemic heparinization is associated with a higher risk of bleeding when used to maintain patency of the extracorporeal circuit during continuous renal replacement therapy (CRRT) in critically ill patients. Regional anticoagulation can be achieved with citrate. Citrate is more frequently used in CRRT to provide regional anticoagulation of the in patients with the high risk of bleeding. The citrate is infused into the extracorporeal circuit before the hemofilter where chelates ionised calcium, thus inhibiting coagulation. The majority of the citrate and chelated calcium is filtrated and/or enters the dialysate and is removed from the circuit. Therefore, calcium must be infused to replace the loss of calcium. The remaining portion of citrate that is not dialyzed enters the patient’s systemic circulation and is metabolised in the liver. Previous studies imply that regional anticoagulation with citrate is an effective and safe form of anticoagulation for CRRT in critically ill patients with a high risk of bleeding.

        Key words: citrate anticoagulation – critically ill – metabolism – CRRT – renal failure – bleeding