# Safety and effectiveness of nafamostat mesylate in continuous renal replacement therapy in patients with sepsis-associated acute kidney injury: a prospective randomized controlled trial

## TL;DR

This study compares nafamostat mesylate and citrate anticoagulation for kidney therapy in sepsis patients, finding nafamostat may be safe and effective.

## Contribution

The study provides new evidence on the safety and effectiveness of nafamostat mesylate in CRRT for sepsis-associated acute kidney injury.

## Key findings

- Nafamostat mesylate prolonged filter lifespan during CRRT compared to regional citrate anticoagulation.
- There was no significant difference in ICU length of stay between the two groups.
- Nafamostat mesylate showed statistically significant improvement in sCr and APTT compared to the control group.

## Abstract

To determine the safety and effectiveness of the anticoagulation regimen nafamostat mesylate for continuous renal replacement therapy in patients with sepsis-associated AKI.

According to the inclusion and exclusion criteria, a total of 42 patients with sepsis and complicated renal function impairment who required CRRT were included. Among them, 2 patients were excluded because their admission time was less than 24 h. Finally, 40 patients were included. The Nafamostat mesylate anticoagulation method was selected for the experimental group and regional citrate anticoagulation was used in the control group.

At admission (experimental group vs. control group), the following findings were obtained: sCr: 391.2 ± 1.94 vs. 389.7 ± 1.46 ummol/L, BUN: 12.97 ± 1.51 vs. 11.86 ± 1.75 mmol/L, APTT: 23.43 ± 1.27 vs. 24.12 ± 1.53 s, and Plt: 80.15 ± 12.27 vs. 83.15 ± 10.35 × 109/L. Four hours after CRRT treatment, the following findings were obtained: sCr: 280.85 ± 1.89 vs. 283.41 ± 1.46 ummol/L, BUN: 12.02 ± 1.55 vs. 11.86 ± 1.75 mmol/L, APTT of prefilter: 41 ± 3.89 vs. 25.31 ± 2.17 s, postfilter: 81.63 ± 3.76 s, Plt: 80.2 ± 13.04 vs. 83.15 ± 10.35 × 109/L, and pH 7.37 ± 0.03 vs. 7.41 ± 0.02. A comparison of sCr and APTT (prefilter) revealed that p<0.05 was statistically significant, but there was no significant difference in the other indicators. In the control group, citrate accumulation occurred in 2 patients; for a total calcium/arterial calcium ion concentration >2.5, there were no obvious adverse reactions. The lifespans of the first filter were 60.2 ± 10.09 and 59.07 ± 11.44 h, and the ICU lengths were 7.35 ± 1.35 and 7.21 ± 1.17 days, Nafamostat mesylate prolonged filter lifespan compared to RCA, however, ICU LOS was same.

The anticoagulation regimen of nafamostat mesylate may be safe and effective in patients with sepsis-associated AKI receiving CRRT.