Zhang W, et al. - Whether regional citrate anticoagulation (RCA) affords a safe and efficacious option for continuous renal replacement therapy (CRRT) in liver failure patients was explored by analyzing studies identified from PubMed, Embase, and the Cochrane Library databases from the inception to March 1, 2018, and enrolled adult (age > 18 years) patients with various levels of liver dysfunction underwent RCA-CRRT. Researchers performed a systematic review including 10 observational studies with 1,241 liver dysfunction patients. Significantly increased serum pH, bicarbonate, and base excess (BE), the rate of metabolic alkalosis, the serum ionized calcium (ionCa) and total calcium (totCa) level, and the ratio of total calcium/ionized calcium (totCa/ionCa) were seen at the end of observation vs baseline values. No significant difference in the pH, serum lactate level, and totCa/ionCa ratio during CRRT were observed among live failure patients vs non-liver failure patients. Overall, RCA appeared safe and could produce a favorable filter lifespan in liver failure patients who undergo CRRT. In patients with liver failure, the closely monitoring the acid base status and electrolyte balance during RCA-CRRT could be more important.