Safe and effective anticoagulation is crucial in continuous renal replacement therapy. Citrate anticoagulation is widely used for its advantages of low bleeding risk, high anticoagulation efficacy, and extended filter lifespan. However, the commonly used citrate-containing anticoagulants in clinical practice, such as 4% trisodium citrate, may impose excessive citrate and sodium loads, increasing the risk of metabolic alkalosis and hypernatremia, especially in patients whose replacement fluid electrolytes are not appropriately adjusted. In recent years, the clinical use of low-concentration sodium citrate-based replacement fluids has reduced the incidence of metabolic disturbances. When combined with calcium-free, phosphate-containing, and low-buffer bicarbonate solutions, this approach offers additional benefits such as simplified workflow, reduced circuit complexity, and improved electrolyte stability, achieving both effective anticoagulation and electrolyte homeostasis.
