Abstract: Continuous renal replacement therapy (CRRT) is a common treatment for acute kidney injury (AKI), especially for patients with shock and tissue hypoperfusion. CRRT can effectively remove various kinds of toxins, maintain the balance of water and electrolytes, and stabilize hemodynamics in these patients. However, due to the continuous blood circulation and filtration during CRRT, the risk of thrombosis is increased, and anticoagulation is therefore necessary. Anticoagulation strategy is particularly complex in patients with shock combined with tissue hypoperfusion and high risk of bleeding, which needs to consider the balance between the effect of anticoagulants and the risks of bleeding and thrombosis. In this article the authors summarize the feasibility and safety of non-anticoagulation, citrate, nafamostat mesylate, argatroban and other common anticoagulation regimens used in CRRT for shock patients with low tissue perfusion and high risk of bleeding.

Key words: Continuous renal replacement therapy, Shock with tissue hypoperfusion, High risk of bleeding, Anticoagulation