Abstract: FR-PO0104
Metabolic Safety of Regional Citrate Anticoagulation During CRRT: A Target Trial Emulation
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Rehman, Aqeeb Ur, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Takeuchi, Tomonori, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Hirata, Kaiho, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Shampa, Sadia Yesmin, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Pranto, Shehan Irteza, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Tolwani, Ashita J., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
- Neyra, Javier A., University of Alabama at Birmingham Health System, Birmingham, Alabama, United States
Background
Assessing the safety of citrate anticoagulation during continuous renal replacement therapy (CRRT), particularly its impact on metabolic complications, remains a critical concern in critical care nephrology.
Methods
We conducted a retrospective target trial emulation using electronic health record data from University of Alabama at Birmingham (UAB). Adults who received CRRT between 01/2012 and 12/2024 were included, excluding the COVID-19 peak years (2020–2021). We excluded patients with shock liver (>1000 IU/L increase in transaminases), lactate>8 mmol/L at CRRT initiation, or severe baseline metabolic abnormalities: hypokalemia (<2.5 mmol/L), hypocalcemia (<7.6 mg/dL), hypomagnesemia (<1.2 mg/dL), hypoglycemia (<40 mg/dL), or acidemia (pH<7.2). Treatment strategy was regional citrate anticoagulation (RCA) using 0.5% sodium citrate (vs. non-RCA or no anticoagulation). A clone-censor-weight approach was applied: the original cohort was duplicated, with one copy assigned to RCA and the other to non-RCA. Artificial censoring was implemented upon protocol deviation, and inverse probability of censoring weights were calculated. Covariates included age, sex, race, BMI, baseline serum creatinine (SCr), Charlson comorbidity index, liver disease, and CKD status (ESKD, CKD, or none), as well as daily SOFA score, vasopressor use, and mechanical ventilation. A weighted pooled logistic regression estimated the association between RCA use and severe metabolic abnormalities within 10 days of CRRT initiation. Odds ratios (OR) and 95% confidence intervals (CIs) were derived using 1000 bootstrap samples.
Results
We analyzed 2,292 patients over 7,138 CRRT patient-days. Of these, 40.4% were female, 38.7% were Black, had median baseline SCr of 1.30 mg/dL (IQR 0.9–2.4), median SOFA score at CRRT initiation of 10 (IQR 8–13), in-hospital mortality was 49.1%, and median CRRT duration was 5 days (IQR 3–10). The odds ratio for severe metabolic abnormalities within 10 days of CRRT initiation was 1.12 (95% CI 0.99–1.29) in the RCA group vs. non-RCA group, indicating no statistically significant association.
Conclusion
RCA during CRRT was not associated with increased risk of severe metabolic abnormalities compared to non-RCA protocols. These results suggest no significant metabolic safety concerns with RCA use.