Unfractionated heparin versus nafamostat mesylate for anticoagulation during continuous kidney replacement therapy: an observational study

Abstract

Background Unfractionated heparin sodium and nafamostat mesylate have long been used as anticoagulants in continuous kidney replacement therapy (CKRT) where citrate is unavailable. This study aimed to determine whether heparin or nafamostat mesylate used during CKRT was associated with a longer filter life. Methods In this single-centre observational study, we included adult patients who required CKRT and used heparin or nafamostat mesylate for their first CKRT in the intensive care unit from September 1, 2013, to December 31, 2020. The primary outcome was filter life (from the start to the end of using the first filter). We used propensity score matching to adjust for the imbalance in patients’ characteristics and laboratory data at the start of CKRT and compared the outcomes between the two groups. We also performed restricted mean survival time analysis to compare the filter survival times. Results We included 286 patients, 157 patients on heparin and 129 patients on nafamostat mesylate. After propensity score matching, the mean filter life with heparin was 1.58 days (N = 91, Standard deviation [SD], 1.52) and with nafamostat mesylate was 1.06 days (N = 91, SD, 0.94, p = 0.006). Multivariable regression analysis adjusted for confounding factors supported that heparin was associated with a longer filter life compared with nafamostat mesylate (regression coefficient, days, 0.52 [95% CI, 0.15, 0.89]). The between group difference of the restricted mean filter survival time in the matched cohort was 0.29 (95% CI, 0.07–0.50, p = 0.008). Conclusion Compared to nafamostat mesylate, heparin was associated with one-third to one-half a day longer filter life. Trial registration Not applicable.

Dose of nafamostat mesylate during continuous kidney replacement therapy in critically ill patients: a two-centre observational study

“…The recommended dosage of nafamostat mesylate indicated in the brochure ranges from 20 to 50 mg/h. However, the dosage pertains to intermittent dialysis [ 12 ], and the optimal dosage for CKRT in critically ill patients remains undetermined [ 13 ]. The literature reports a range of nafamostat dosing.…”

Filter Lifespan, Treatment Effect, and Influencing Factors of Continuous Renal Replacement Therapy for Severe Burn Patients

“… 25 Among patients with AKI, sodium citrate anticoagulation resulted in a notably extended filter lifespan in comparison to heparin anticoagulation. 26 , 27 Nafamostat mesylate, a synthetic serine protease inhibitor, 28 is often used in CRRT procedures in Japan and South Korea. 29 , 30 A study has shown that nafamostat mesylate is both safe and effective for critically ill patients undergoing blood purification.…”