Abstract: Objective To investigate the anticoagulant effect and safety of two-stage regional citrate anticoagulation regimen used in daytime continuous renal replacement therapy with calcium-containing replacement fluid. Methods A total of 96 patients who received daytime renal replacement therapy in a tertiary hospital in Wuhan were selected and randomly divided into experimental group and control group by 2:1. Two-stage citrate anticoagulation regimen was used in experimental group and traditional citrate anticoagulation regimen was used in control group. The incidence of tube plugging,coagulation grade of the filter and vein pot after disoperation,calcium ion concentration 2 h after beginning,and relative blood gas index and total calcium/ionic calcium ratio at the end of treatment were compared between the two groups. Results The incidence of tube plugging in the experimental group was lower than that in the control group,the difference was statistically significant（χ²=4.980,P<0.05）. The coagulation grade of the vein pot in the experimental group was significantly better than the control group,the difference was statistically significant（Z=3.556,P<0.001）.The 2 h venous calcium concentration of experimental group was lower than that of control group,and the difference was statistically significant（t=7.418,P<0.001）. At the end of treatment,the relevant blood gas markers in both groups were within the normal range,total calcium/ionic calcium<2.5,the difference was not statistically significant（P>0.05）. Conclusion Two-stage regional citrate anticoagulation can reduce the incidence of tube clotting in continuous renal replacement therapy with calcium replacement fluid and improve the anticoagulant effect of vein pot. At the same time,the scheme does not increase the risk of citrate accumulation,so it is a safe anticoagulant choice.

Key words: Two-stage Regional Citrate anticoagulation, Calcium-containing Replacement Fluid, Continuous Renal Replacement Therapy, Monitoring, Calcium Ion Concentration