A Prospective, Observational Study to Evaluate the Safety and Feasibility of Continuous Renal Replacement Therapy With Regional Citrate Anticoagulation in a Cohort Critical Ill Patients With Acute Kidney Injury and Presumed Absent Citrate Metabolism

Use of regional citrate anticoagulation in an at risk population with decreased citrate metabolism. This study assesses the feasibility and safety of regional citrate anticoagulation in this population.

Inclusion Criteria: * Need for renal replacement therapy in the ICU with any of the following criteria: * anticipation of severely impaired citrate metabolism (serum lactate ≥ 5 mmol/l in patients with shock or requirement of a dextrose drip to prevent hypoglycemia or spontaneous INR \> 3 and/or requirement of fresh frozen plasma to maintain INR \< 3 in patients with cirrhosis or acute liver failure or acute on chronic liver failure) * development of citrate toxicity under CRRT with RCA due to worsening citrate metabolism Exclusion Criteria: * Pregnancy * A known hypersensitivity to citrate compounds * Refusal of informed consent