Evaluation of the efficacy and safety of nafamostat mesylate anticoagulation and citric acid anticoagulation in chronic renal failure patients with high-risk bleeding during continuous renal replacement therapy
Zhang Qiaona
Li Lu
Abstract：Objective To evaluate the safety and efficacy of nafamostat mesylate(NM)and regional citric acid(CA)anticoagulation in continuous renal replacement therapy(CRRT)in chronic renal failure patients with high-risk bleeding.Methods A retrospective study was conducted in chronic renal failure patients with high-risk bleeding who received NM or CA anticoagulation at our center from January 2021 to September 2023 to assess filter lifespan or bleeding and other complications.Multifactor Cox regression analysis was used to determine the risk factors associated with filter failure.Results A total of 125 cases were included,of which 59 received CA anticoagulant and 66 received NM anticoagulant.Compared with the CA group,the NM group had higher rates of hypertension and coronary heart disease,and there was no significant difference in other baseline characteristics between the two groups.The filter lifespan of CA group was longer than that of NM group[12 h(8～24)vs 8 h(8～13.13),P=0.003].Patients in the NM group had a significantly higher risk of filter failure(HR=22.89,95%CI 3.935～133.12,P<0.001).However,in CRRT less than 8 hours,the clotting rate of the two anticoagulant methods was comparable.There were 6 cases(10.17%)of new bleeding in CA group,which was similar to 9 cases(13.64%)in NM group(P=0.552).The transfusion of plasma,red blood cells and platelets were not different between the two groups.The incidence of metabolic alkalosis(5.08%)in CA group was slightly higher than that(4.55%)in NM group(P=0.042).Conclusion Compared with CA anticoagulation in CRRT at high risk of bleeding in chronic renal failure,the anticoagulation effect of NM is slightly worse,however its risk of bleeding is comparable with CA anticoagulation,and it can meet the treatment within 8 h.
Keywords：Continuous renal replacement therapyCitric acidAnticoagulationNafamostat mesylateChronic renal failureHigh-risk bleeding
Publication Date：2024-06-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 197-203 )