Objective To explore the effect of segmental citrate anticoagulation on unplanned discontinuation of continuous renal replacement therapy (CRRT), and to provide a reference for clinical CRRT quality management. Methods  Eighty CRRT patients in the intensive care unit of Affiliated Hospital of Hebei University from January to September 2025 were retrospectively selected and divided into a segmental anticoagulation group and a non-segmental anticoagulation group. Indicators including general data, treatment duration, unplanned discontinuation rate, venous chamber coagulation, transmembrane pressure, return pressure, laboratory test results, and average treatment cost were collected, and the differences in these indicators between the two groups were compared. Results  The incidence of unplanned discontinuation (χ²=9.928, P=0.002), the incidence of venous chamber coagulation (χ²=12.679, P=0.002), and the average treatment cost (t=-5.498, P＜0.001) in the segmental anticoagulation group were all lower than those in the non-segmental anticoagulation group, while the average treatment duration (t=7.576, P＜0.001) was longer. There were no significant overall differences in internal environment indicators between the two groups during treatment, except that the post-filtration ionized calcium in the segmental anticoagulation group was slightly higher than that in the non-segmental anticoagulation group at the 6th hour of treatment (t=2.793, P=0.007), but this difference was within the clinical safety range. At the end of treatment, no significant differences were observed between the two groups in peripheral ionized calcium (t=-0.769, P=0.444), post-filtration ionized calcium (t=-0.358, P=0.721), pH value (t=1.030, P=0.306), or bicarbonate ion (t=-0.883, P=0.380). Conclusion  Segmental citrate anticoagulation can effectively reduce the incidence of CRRT unplanned discontinuation, improve the efficiency of CRRT treatment, and reduce the economic burden on patients.