Citrate has been proposed as anticoagulation of choice in continuous renal replacement therapy (CRRT). However, little is known about the pharmacokinetics (PKs) and metabolism of citrate in liver failure patients who require CRRT with regional citrate anticoagulation (RCA).

This study aimed to evaluate citrate PKs, metabolic complications, and clinical outcomes among critically ill acute liver failure (ALF) and acute on top chronic liver failure (ACLF) patients receiving CRRT.

Inclusion Criteria:

• Critically ill ALF or ACLF adult patients with AKI
• aged ≥ 18 y old
• Currently receiving CRRT.

Exclusion Criteria:

• severe acidosis (pH < 7.1) or severe alkalosis (pH > 7.55)
• blood transfusion within 24 h prior to the study
• use of citrate-containing medications
• severe hypocalcemia (serum ionized calcium < 0.8 mmol/L)
• use of heparin as anticoagulation