Stability of citrate and calcium dosing in citrate renal replacement therapy.

Citrate is the recommended anticoagulant for continuous renal replacement therapy (RRT)[1], and is thought to confer numerous benefits, including more continuous hours of filtration, fewer total circuits used, less overall cost and maybe improved patient and kidney survival when compared with heparin anticoagulation[2]. Citrate is run pre filter, calcium is infused post filter, the rates of both determined by the filter and patient ionised calcium level respectively. This is monitored by blood tests, which must be sampled frequently. Filter and patient ionised calcium levels, citrate and calcium infusion rates, are recorded as part of clinical practice at RSCH. The target plasma ionised calcium concentration is 1.0 - 1.2mM, the target filter ionised calcium concentration is 0.25 - 0.5mM.