Metabolic Complications Using a Low- Versus High Concentration Citrate Solution for Regional Anticoagulation in Continuous Kidney Replacement Therapy: A Pragmatic Randomized Trial

This study is a pragmatic, randomized trial comparing two commercially available citrate solutions to determine their impact on metabolic complications in critically ill patients with acute kidney injury receiving continuous kidney replacement therapy with regional citrate anticoagulation.

Inclusion Criteria: * Any adult patient admitted to the intensive care unit with acute kidney injury requiring continuous kidney replacement therapy Exclusion Criteria: * expected duration of continuous kidney replacement therapy less than 96 hours * prior continuous kidney replacement therapy before inclusion * a known hypersensitivity to citrate, acute liver failure or liver cirrhosis Child-Pugh C * persistent severe hemodynamic shock with decreased lactate clearance * a high likelihood of dying within the first 24h after initiation of CKRT * preexisting severe electrolyte disorders before CKRT initiation not attributable to Acute kidney injury