Liu etal.Military Medical Research (2023)10:23https::/dol.org/10.1186s40779-023-00457-9MMR MILITARY MEDICAL RESEARCHPOSITION ARTICLE AND GUIDELINEOpen AccessManagement of regional citrateanticoagulation for continuous renalreplacement therapy:guidelinerecommendations from Chinese emergencymedical doctor consensusShu-Yuan Liu't,Sheng-Yong Xu2t,Lu Yin3t,Ting Yang Kui Jins,Qiu-Bin Zhang,Feng Sun,Ding-Yu Tan8,Tian-Yu Xin,Yu-Guo Chen1011,Xiao-Dong Zhao2,Xue-Zhong Yu2,Jun Xu2 and Emergency MedicalDoctor Branch of the Chinese Medical Doctor AssociationAbstractContinuous renal replacement therapy (CRRT)is widely used for treating critically-ill patients in the emergencydepartment in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation duringCRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective and is nowrecommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards forRCA management in the world,and there are many problems in using this method in clinical practice.The EmergencyMedical Doctor Branch of the Chinese Medical Doctor Association (CMDA)organized a panel of domestic emergencymedicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages anddisadvantages of RCA in CRRT anticoaqulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidenceas well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resourceutilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations wereformed from the experts'consensus.Keywords Continuous renal replacement therapy,Emergency,Anticoagulation,Citrate,Guideline,Expert consensusShu-Yuan Liu Sheng-Yong Xu and LuYin contributed equally to this workBackgroundCorrespondence:Due to limited resources of critical therapy could notYu-Guo Chenfully meet growing medical requirements in China,somechen919085@sdueducncontinuous renal replacement therapy (CRRT)treat-Xiao-Dong Zhaoxd63715@126c0mments for emergent and critically-ill patients had to beXue-Zhong Yuperformed in emergency departments.For the success ofyx@pumch.cnthese CRRT treatments,anticoagulant therapy was essen-Jun Xuxujunfree@1 26.comtial,which was needed to prevent clotting in the extra-Full list of author information is available at the end of the articlecorporeal circulation during CRRT.Previously systemicBMCThe Author(s)2023.Open AccessThis artidle is licensed undera Creative Commons Attribution 40 Intemnational License,whichpermits use,sharing adaptation,distribution and repoducton in any medium orfomat as long as you give appropriateceditto theofiginal author(s)and the source,provide a link to theCeative Commons licence,and indicate if changes wee made.The images ort
