Risk of Hyperkalemia Caused by Nafamostat Mesilate in Geriatric Patients

Abstract

Nafamostat mesilate (NM) is used clinically for the prevention and treatment of pancreatitis. Electrolyte monitoring is necessary in geriatric patients receiving NM as it may cause hyperkalemia with the possibility of inducing arrhythmias. We attempted to evaluate the risk of hyperkalemia with aging and its background in this retrospective cohort study. Thirty-six of 290 patients (12.4％) who were receiving NM for the prevention and treatment of pancreatitis experienced hyperkalemia at the Kanazawa Medical Center over the past 2 years. A multiple logistic regression analysis was performed to identify the risk factors for hyperkalemia. The results showed that signi cant predictors of hyperkalemia were increasing age (per 10 years; odds ratio [OR]: 1.41, 95％ con dence interval [CI]: 1.01 -1.96, P < 0.045), fever (OR: 3.11, 95％ CI: 1.25 -7.71, P < 0.015), a high daily dose (per 10 mg/body/day; OR: 1.10, 95％ CI: 1.01 -1.20, P < 0.038), and a high serum potassium level at the start of treatment (per mEq/L; OR: 2.86, 95％ CI: 1.40 -5.83, P < 0.004). Thus, prior to the initiation of treatment with NM, it is necessary to assess the patientʼs medical background and to perform electrolyte monitoring frequently. We suggest that dosage reduction should be considered in the treatment of geriatric patients undergoing long-term treatment with NM.

Incidence and risk factors for hyperkalaemia in patients treated for COVID‐19 with nafamostat mesylate

“…A previous study also found the age and duration of treatment were risk factors for hyperkalaemia in patients treated for acute pancreatitis with NM. 21 Basic research suggests that the ENaC expression level decreases with age in rats. 40 In addition, it has been suggested that the ability to secrete aldosterone in response to elevated potassium is reduced in older adults.…”

“…We examined the use of NM for treating COVID‐19 to clarify the risk factors for hyperkalaemia. We performed multivariable logistic regression analysis using the presence of hyperkalaemia as the dependent variable and the presence of fever and serum potassium level before NM administration, which have been shown to influence the increase in serum potassium level in previous studies, 21 and age and duration of NM administration, which were significantly associated with hyperkalaemia in the univariate analysis as independent variables. The analysis showed that prolonged NM administration was a risk factor for the development of hyperkalaemia.…”

“…The independent variables were factors that have been suggested as independent risk factors in previous studies (age, presence of fever, duration of NM administration and serum potassium level before NM administration). 21 In addition, Pearson's correlation coefficient was used to screen variables for multicollinearity. If two factors showed a strong correlation (r > 0.8), one of the two factors was excluded from the model.…”

“…NM has been reported to be a risk factor for hyperkalaemia in patients with acute pancreatitis. 21 There have been two case reports of NM‐induced hyperkalaemia in patients with COVID‐19, 22 , 23 but the incidence and risk factors for NM‐induced hyperkalaemia in patients with COVID‐19 are unknown.…”

“…As SARS‐CoV‐2 infection may affect serum potassium regulation, the incidence of hyperkalaemia due to NM may differ in COVID‐19 patients from that in patient with other conditions. NM has been reported to be a risk factor for hyperkalaemia in patients with acute pancreatitis 21 22,23 but the incidence and risk factors for NM‐induced hyperkalaemia in patients with COVID‐19 are unknown.…”