Roveri G, Busana M, Lusardi AC, et al. - Given the necessity for an infusion of calcium to replace the calcium lost in the effluent during citrate-based Continuous Renal Replacement Therapy (CRRT), and that the replacement takes place through a central venous catheter (CVC) that is primed with saline solution, researchers hypothesized a potential systemic anticoagulation caused by the unchelated citrate reaching the patient at the start of CRRT because of 0.42 ml of line dead space. They studied two subpopulations of 7 patients who underwent Continuous Veno-Venous Hemodiafiltration (150 ml/min of blood flow, 1500 ml/h dialysate flow, 1500 ml/h of citrate predilution) in this pilot study. CVC primed with saline was used in one and with calcium chloride 10% was used in the second. The calcium replacement rate of 6.3 ± 0.2 ml/h was reported. The group with saline priming exhibited a transient period of hypocalcemia (ionized calcium concentration [iCa] < 1.00 mmol/l for the first 2 hours). This was not reported in the subpopulation with the calcium priming. Outcomes support the efficacy of priming the catheter with calcium in avoiding the potential issue regarding citrate accumulation at the start of CRRT.