The first descriptions of regional citrate anticoagulation (RCA) to maintain circuit patency in continuous kidney replacement therapy (CKRT) were reported 30 years ago.1 More recently, the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) acute kidney injury (AKI) guideline advocated for citrate as first-line anticoagulation for CKRT.2 Despite this, there has been relatively modest uptake of citrate anticoagulation, and heparin continues to be the most commonly used anticoagulant for CKRT.3