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Sodium citrate was used as a regional anticoagulant in the dialysis system in four patients with acute renal failure and active bleeding of various sources during a total of 38 dialysis treatments. All four patients had exacerbation of existing hemorrhage with low-dose heparin dialysis. A special circuit was used through which sodium citrate was infused into the arterial sleeve of the dialysis blood line; dialysis was achieved against calcium-free bath and calcium was infused into the venous sleeve of the dialysis blood line. When data was compared to low-dose heparin dialysis, citrate anticoagulation is as effective, carries no risk of exacerbation of bleeding, and had negligible adverse effects.