Poh CB, Tan PC, Kam JW, et al. - Given that conventional regional citrate anticoagulation (RCA)-continuous renal replacement therapy (CRRT) citrate dose ranges from 3–5mmol per litre of blood, researchers undertook this prospective observational study to investigate whether an RCA protocol with lower citrate dose would be efficacious as well as how it would influence citrate-related complications. Two RCA-CRRT protocols in ICU were compared: RCA Protocol 1 employed an initial citrate dose of 3.0mmol/L while Protocol 2 started with 2.5mmol/L. To target circuit-iCa 0.26–0.40mmol/L, citrate dose was titrated by sliding scale. Reinfusion of calcium post-dialyzer, as well as titration by protocol to target systemic-iCa 1.01–1.20mmol/L, was done. Overall 200 RCA-CRRT sessions were conducted (81 Protocol 1; 119 Protocol 2). Less citrate-related complications were seen with no loss of efficacy in correlation with the use of the RCA protocol with a lower initial citrate dose of 2.5mmol/L blood. Unnecessary citrate exposure can be prevented as well as safety can be improved via a more precise RCA prescription at the commencement of treatment.