[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-451982-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-451982-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","disenchantment-the-overstated-impact-of-citrate-concentration-on-accumulation-risk","Disenchantment: the overstated impact of citrate concentration on accumulation risk","","Citrate accumulation poses a relevant complication in continuous kidney replacement therapy (CKRT). In response to a commentary, the authors reanalyzed data from a cohort of 911 critically ill patients and assessed associations with citrate accumulation, including bilirubin levels, technical parameters, and CKRT modality. CVVHDF showed a lower risk than CVVHD. Although device-specific citrate regimens differed and multiFiltrate used higher citrate loads, total citrate load was not independently linked to accumulation at initiation or at the accumulation time. Modality remained significantly associated after adjustment, implying mechanisms beyond citrate load.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/disenchantment-the-overstated-impact-of-citrate-concentration-on-accumulation-risk/451982/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/disenchantment-the-overstated-impact-of-citrate-concentration-on-accumulation-risk/451982.png","ImageObject",300,407,{"name":42,"@type":43},"Aldword","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What complication is addressed in the study?","Question",{"text":63,"@type":64},"The study focuses on citrate accumulation as a relevant complication of continuous kidney replacement therapy (CKRT).","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How did CKRT modality relate to citrate accumulation risk?",{"text":68,"@type":64},"Continuous venovenous haemodiafiltration (CVVHDF) was associated with a lower risk of citrate accumulation compared with continuous venovenous haemodialysis (CVVHD).",{"name":70,"@type":61,"acceptedAnswer":71},"Did citrate load or citrate concentration independently predict accumulation?",{"text":72,"@type":64},"Total citrate load was not independently associated with citrate accumulation at therapy initiation or at the time of accumulation, while modality remained significantly associated after multivariable adjustment.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},451982,1790820118,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":111,"preview_page_count":4},2336478940917,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Müller et al. Critical Care (2026) 30:11 [https://doi.org/10.1186/s13054-026-05835-y](https://doi.org/10.1186/s13054-026-05835-y)  \nCritical Care  \nMATTERS ARISING Open Access  \nDisenchantment: the overstated impact  of citrate concentration on accumulation risk  \nMattia M. Müller 1, Alexa Weber1 and Sascha David 1,2*  \nAbstract  \nCitrate accumulation is a relevant complication of continuous kidney replacement therapy (CKRT) . In response to the commentary by Wang and Li, we reassessed findings from a cohort of 911 critically ill patients, in whom bilirubin levels, technical parameters, and CKRT modality were independently associated with citrate accumulation. Continuous venovenous haemodiafiltration (CVVHDF) was associated with a lower risk compared with continuous venovenous haemodialysis (CVVHD) . While this difference was initially hypothesised to reflect transmembrane flux and membrane patency, Wang and Li highlighted potential confounding by device-specific citrate concentrations. We acknowledge this limitation, as CVVHDF was delivered exclusively using the Prismaflex system, whereas CVVHD was performed with the multiFiltrate device that both use different citrate regimens. Although multiFiltrate was associated with a higher citrate load, total citrate load was not independently associated with citrate accumulation at therapy initiation or at the time of accumulation. Importantly, treatment modality remained significantly associated with citrate accumulation after multivariable adjustment. These findings suggest that factors beyond citrate load contribute to citrate accumulation, warranting further investigation.  \nDear Editor,  \nReading with great enthusiasm the comment by Wang and Li entitled “Unraveling the true determinants of citrate accumulation in continuous kidney replacement therapy: the overlooked role of citrate concentration and dilution modality” (REF), we are delighted by the interest our work has generated within the expert community regarding risk stratification of citrate accumulation during continuous kidney replacement therapy (CKRT) [1].  \nThis reply refers to the comment available online at [https://doi.org/1](https://doi.org/1)[ ](https://doi.org/1)[0.1186/s13054-025-05816-7](0.1186/s13054-025-05816-7.)[.](0.1186/s13054-025-05816-7.)  \n*Correspondence: Sascha David  \nsascha.david@usz.ch  \n1Institute of Intensive Care Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland  \n2Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany  \nExamining our findings from a large cohort of 911 critically ill patients, we identified several factors significantly associated with citrate accumulation, including bilirubin levels before initiation of CKRT, the technical machine settings (blood-to-dialysate plus substitution flow ratio), and the treatment modality. Notably, continuous venovenous haemodiafiltration (CVVHDF) was associated with a lower risk of citrate accumulation compared to continuous venovenous haemodialysis (CVVHD).  \nA plausible explanation for this difference between CKRT modalities could lie in different transmembrane fluxes. While all membranes gradually lose efficacy during treatment, this effect may be partially compensatedin CVVHDF by maintaining a constant transmembrane substitution flux. This mechanism may help preserve membrane patency and could explain why CVVHD devices appear more susceptible to declining membrane performance [2, 3]. We therefore hypothesised that, in CVVHD, deterioration in membrane patency may more  \n© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licen","cbCainZ66iI6YajX","https://ap.wps.com/l/cbCainZ66iI6YajX","pdf",911673,"English","# Abstract\n# Response to the commentary\n## Patient cohort and independent associations\n## Interpretation of modality differences\n## Discussion of citrate concentration and device effects","[{\"question\":\"What complication is addressed in the study?\",\"answer\":\"The study focuses on citrate accumulation as a relevant complication of continuous kidney replacement therapy (CKRT).\"},{\"question\":\"How did CKRT modality relate to citrate accumulation risk?\",\"answer\":\"Continuous venovenous haemodiafiltration (CVVHDF) was associated with a lower risk of citrate accumulation compared with continuous venovenous haemodialysis (CVVHD).\"},{\"question\":\"Did citrate load or citrate concentration independently predict accumulation?\",\"answer\":\"Total citrate load was not independently associated with citrate accumulation at therapy initiation or at the time of accumulation, while modality remained significantly associated after multivariable adjustment.\"}]","Disenchantment: the overstated impact of citrate concentration on accumulation risk | PDF",1790736261]