Citrate anticoagulation to reduce mortality in patients needing continuous renal replacement therapy

Citrate regional anticoagulation in continuous renal replacement therapy (CRRT) is a relatively recent technique, which was developed to reduce the complications of anticoagulation in critically ill patients at high risk of bleeding. Citrate anticoagulation was demonstrated to reduce the bleeding and the overall complication rate in critically ill patients on CRRT, without shortening circuit survival. Citrate anticoagulation is the only anticoagulation technique that demonstrated to reduce mortality in critically ill patients with acute kidney injury, when compared with other techniques. With technological improvement and development of more reliable protocols and management algorithms, citrate could become the first choice for anticoagulation during CRRT in critically ill patients.