Starting a CRRT in India is never early, it definitely takes a long time to in India to convince a patient to undergo CRRT(continuous renal replacement therapy) due to financial reasons and other social reasons.By the time we start CRRT in India most of the patients are in severe shock/metabolic acidosis requiring multiple vasopressors ,in this clinical scenario these patients require good anticoagulant to keep the circuit patent and treating physician should be aware of all the pros and cons of using anticoagulant drugs.As regional citrate anticoagulation (RCA) is still in development in Indian scenario we compared diluted vs concentrate citrate anticoagulant in Indian patient population.

Figure 1

The analysis included 12 circuits in the concentrated citrate group and 30 circuits in the diluted citrate group.After observation we found that filter life span and citrate toxicity was similar in both groups, membrane clogging and electrolytes replacement was more in diluted citrate group than concentrate citrate group, better solute clearance/metabolic alkalosis /risk of hypernatremia was more in concentrate citrate group than diluted citrate group.Nursing workload is more in concentrate citrate protocol than diluted citrate protocol.Statistically significant results was drawn because of less number of patients in each group.

As the primary target is to increase the filter life span and decrease metabolic complications related to RCA ,with better understanding of RCA protocols and fluids used for RCA both dilute and concentrate RCA protocols can be safely practiced in India.However as all commercial fluids required for the use of concentrate RCA is still not available in India,there is more nursing/dialysis technicians workload in preparing bedside custom made solutions for concentrate citrate protocol which might be decreased in future with availability of all commercially available fluids.