Abstract: Objective To explore the effect and safety of regional citrate anticoagulation in patients with hemodialysis at high risk of bleeding.Methods Twenty patients with hemodialysis at high risk of bleeding were enrolled, and 4% sodium citrate was used for hemodialysis. Blood K⁺, serum total calcium, serum sodium, blood chloride, blood pH value, serum creatinine, blood urea nitrogen, calcium ion concentration at filter end of dialysis 2 h, activated clotting time before and after hemodialysis were analyzed. Bleeding during hemodialysis, coagulation in extracorporeal circulation, and adverse reactions (lips numbness, limb convulsions, muscle spasms) were observed.Results Twenty patients underwent 70 case-times of hemodialysis and hemodialysis time was 4 h. Blood K⁺, serum creatinine, and urea nitrogen after hemodialysis were significantly reduced as compared with those before hemodialysis (P<0.05). The concentrations of calcium ion at the end of the filter was (0.58±0.20) mmol/L after dialysis at 2 h, and the blood glucose was significantly lower than that before dialysis (P<0.05). There was no significant difference in pH value, activated clotting time, blood Cl^-, serum total calcium concentration and blood Na⁺ before and after hemodialysis (P>0.05). Hypocalcemia occurred in 4 cases (20%), and one case of cerebral hemorrhage withdrew the treatment due to aggravated hernia hernia. No bleeding or bleeding aggravation occurred in hemodialysis. There were 3 cases of grade I coagulation (4.3%).Conclusions Regional citrate anticoagulation is effective in hemodialysis patients with high risk of hemorrhage, and has good safety. During the course of treatment, blood calcium is monitored.