In vitro anticoagulation is a key technique in continuous renal replacement therapy (CRRT), and heparin was once the preferred anticoagulant for CRRT, but its clinical application is limited due to the high risk of bleeding. Citrate, as a new regional anticoagulant, has received more and more attention and recommendation in recent years, but there are still controversies over its application in patients with liver failure. With reference to relevant literature in China and globally, this article reviews the metabolic characteristics and monitoring methods of regional citrate anticoagulation and its safety in CRRT for patients with liver failure.