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New research · Nephrology
Advances in therapy · 16h
Meta-analysisAdvances in therapy · 2026

Regional Citrate Anticoagulation Versus No Anticoagulation During Continuous Renal Replacement Therapy in Critically Ill Patients at High Risk of Bleeding: A Meta-analysis of Randomized Controlled Trials.

Wenlong Li, Jun Xie, Chong Huang … Yan Chen
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NephrologyMeta-analysis

Regional citrate anticoagulation prolongs continuous renal replacement therapy filter lifespan versus no anticoagulation

Regional Citrate Anticoagulation Versus No Anticoagulation During Continuous Renal Replacement Therapy in Critically Ill Patients at High Risk of Bleeding: A Meta-analysis of Randomized Controlled Trials.

Wenlong Li et al. · Advances in therapy · 2026
Background

Continuous renal replacement therapy (CRRT) in critically ill patients often requires anticoagulation to maintain circuit patency, but systemic anticoagulation may increase bleeding risk.

Methods

PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and China National Knowledge Infrastructure were searched for randomized controlled trials comparing RCA with NA during CRRT in adult critically ill patients with high bleeding risk.

n = 893 patients
Results

citrate anticoagulation kept the blood-filter working longer before it clogged and had to be replaced

RR by subgroup · 95% CI
null = 1
incidence of circuit clotting
0.20
citrate accumulation
4.67
hypocalcemia
1.78
groups
1.34
RCA significantly reduced major bleeding
0.37
More results

RCA was associated with higher risks of citrate accumulation (RR: 4.67; 95% CI 1.30-16.77) and hypocalcemia (RR: 1.78; 95% CI 1.12-2.83), while acid-base disturbances were not significantly different between groups (RR: 1.34; 95% CI 0.60-3.03).

More results

In addition, RCA significantly reduced major bleeding (RR: 0.37; 95% CI 0.16-0.87), but did not significantly affect the in-hospital mortality (RR: 0.82; 95% CI 0.65-1.04).

“
Conclusion · 1 of 2

RCA improves circuit patency during CRRT in critically ill patients with a high risk of bleeding, although it increases the risk of certain metabolic complications but does not affect mortality.

Conclusion · 2 of 2

While RCA was associated with fewer reported major bleeding events than no anticoagulation, the certainty of evidence for this outcome was low and the finding should be interpreted with caution.

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