Citrate Anticoagulation
For physicians in nephrology & critical care

Citrate Anticoagulation. Evidence. Protocols. Practice.

Apply citrate anticoagulation in practice — from setting up CRRT to troubleshooting. For critical care and nephrology teams, with device-specific protocols, monitoring schemes, and current evidence.

View protocols CRRT dosing calculator
🚀 Understand RCA

New to citrate? The principle in 5 minutes.

 ⚙️ Set up RCA

Starting CRRT? Find the protocol for your device.

 🚨 Troubleshoot

Something doesn't look right? Find the likely cause.

Continuous procedures (CRRT) — standard

Citrate is cited by numerous current guidelines and expert recommendations as the preferred anticoagulation strategy for CRRT (CVVHD/CVVHDF/CVVH) (see Indication). The concrete implementation differs by device used:

Standard procedure

CVVHD (general)

Device-independent basic principle: target values for filter iCa, systemic iCa, and total Ca/iCa.

device-independent base protocol
Standard procedure

Prismaflex / Prismax

Concrete practice protocol with flow rates, dialysate composition, and calcium substitution tables.

Baxter
Standard procedure

multiFiltrate Ci-Ca

Citrate/calcium adjustment schemes and dialysate composition (Ci-Ca Dialysate K2/K4).

Fresenius
Standard procedure · CVVH

Aquarius

Runs in CVVH mode (not CVVHD) — protocol tiers by body weight (Orange/Purple/Green/Grey).

Nikkiso
Standard procedure

OMNI

Suitable for CVVHD/CVVHDF (not CVVH) — including the distinction between net citrate overload vs. true accumulation.

B. Braun

Intermittent dialysis / SLED — off-label

Citrate anticoagulation is off-label here; protocols vary more between centers than for CRRT. See also the overview: why off-label?

Off-label

Intermittent HD (Ca-dialysate)

Three published study protocols for standard HD machines, with exact dosing and safety data.

Fresenius / Gambro / Nikkiso
Off-label

Genius system

Can be used both for intermittent dialysis and as SLED (sustained low-efficiency dialysis).

Fresenius
Off-label · different technique

Fresenius 6008 (Citrate Dialysate)

Citrate-containing dialysate as a heparin-free alternative in chronic HD — not classic RCA.

Fresenius

Latest literature

Loaded automatically from PubMed, sorted by publication date. Shows only title/authors/journal — follow the link to PubMed for abstracts.

Loading recent publications…

The content on this site is for professional orientation only and does not replace individual clinical judgment. Protocols must be reviewed and approved by the respective center. Off-label uses are marked accordingly.