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The introduction of regional citrate anticoagulation to intensive care units has not improved outcomes for patients and is likely to have substantially increased costs.

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Doug W Gould 1, James Doidge 1, M Zia Sadique 2, Mark Borthwick 3, Robert Hatch 4, Fergus J Caskey 5,6, Lui Forni 7,8, Robert F Lawrence 9, Clare MacEwen 3, Marlies Ostermann 10, Paul R Mouncey 1, David A Harrison 1, Kathryn M Rowan 1, J Duncan Young 4, Peter J Watkinson 4,*

1 Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
2 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
3 John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
4 Kadoorie Centre for Critical Care Research and Education, NIHR Biomedical Research Centre, Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
5 UK Renal Registry, Bristol, UK
6 Population Health Sciences, University of Bristol, Bristol, UK
7 Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK
8 Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
9 Patient representative, , Oxford, UK
10 Department of Intensive Care, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
* Corresponding author Email: peter.watkinson@ndcn.ox.ac.uk

Declared competing interests of authors: Peter J Watkinson was the Chief Medical Officer for Sensyne Health plc (Oxford, UK) and holds shares in the company, and has received grant funding from the National Institute for Health Research (NIHR), Wellcome Trust and Sensyne Health plc outside the submitted work. He was also a member of the NIHR Health Technology Assessment (HTA) European Economic and Social Committee (EESC) Methods Group, NIHR HTA EESC Panel and the NIHR, HTA Programme, Prioritisation Committee and methods group: Hospital based care (B), previously HTA Elective and Emergency Specialist Care Panel (April 2015–November 2019) and NIHR Invention for Innovation Product Development Awards Panel (2018–present). Lui Forni has received grant funding from Baxter International Inc. (Deerfield, IL, USA) outside the submitted work. Fergus Caskey has received honoraria from Baxter International Inc. outside the submitted work. Kathryn M Rowan was a member of the NIHR Health and Social Care Delivery Research Board (2014–19). J Duncan Young was a consultant advisor for the NIHR Efficacy and Mechanism Evaluation (EME) programme and a member of the NIHR EME Funding Committee, NIHR EME Sub-Group Remit Check and NIHR EME Strategy Advisory Committee during the conduct of the study (October 2012–December 2019).

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