Journal of Artificial Organs

, Volume 22, Issue 4, pp 341–344 | Cite as

Regional citrate anticoagulation and influence of recirculation on ionized calcium levels in the circuit

  • Anais Degraeve
  • Etienne Danse
  • Pierre-François Laterre
  • Philippe HantsonEmail author
  • Alexis Werion
Case Report Artificial Kidney / Dialysis


Regional citrate anticoagulation is now widely used during continuous renal replacement therapy (CRRT), and especially in patients at risk for hemorrhagic complications. A close monitoring is required to avoid citrate overload, leading to metabolic alkalosis or citrate intoxication causing metabolic acidosis. This case report describes a dysfunction of the regional citrate anticoagulation due to the development of a deep vein thrombosis close to the site of insertion of the venous CRRT catheter. The result was a local recirculation in the circuit with a local citrate overload (acidosis and non-measurable calcium). In the patient’s blood samples, the [calciumtotal/Ca2+systemic] ratio remained normal as a proof of local citrate accumulation without systemic effects. Initially, CRRT remained effective, but due to the progressive decrease of serum creatinine and cystatin C clearance, the site of catheter insertion was changed.


Regional citrate anticoagulation Recirculation Continuous renal replacement therapy 


Compliance with ethical standards

Conflict of interest

All the authors have no conflict of interest to disclose.

Informed consent

A written consent was obtained from the relatives.


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Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  1. 1.Department of Intensive CareCliniques Universitaires Saint-LucBrusselsBelgium
  2. 2.Department of Radiology, Cliniques Saint-LucUniversité Catholique de LouvainBrusselsBelgium

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