# Efficacy and safety of nafamostat mesylate versus heparin anticoagulation in adult kidney disease patients using continuous renal replacement therapy: a systematic review and meta-analysis

## TL;DR

This study compares nafamostat mesylate and heparin for anticoagulation in kidney disease patients on CRRT, finding similar safety but shorter hospital stays with nafamostat.

## Contribution

The study provides a systematic review and meta-analysis comparing two anticoagulants in CRRT for kidney disease patients.

## Key findings

- Nafamostat mesylate and heparin showed similar filter lifespan and bleeding safety.
- Nafamostat significantly reduced hospital stay and thrombin time compared to heparin.
- No significant differences were observed in APTT or INR between the two anticoagulants.

## Abstract

Anticoagulation is essential during continuous renal replacement therapy (CRRT) for acute kidney injury to maintain circuit patency and balance bleeding risks.

Systematically compare the anticoagulant efficacy and safety of nafamostat mesylate (NM) versus heparin in CRRT.

We searched China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine, PubMed, Embase, Cochrane Library, and Web of Science up to June 30, 2025 for randomized or non-randomized controlled trials. A meta-analysis was performed using RevMan version 5.4 software.

Seven retrospective cohort studies comprising were included. No significant differences between the two groups regarding filter lifespan [MD = -1.05; 95% CI (-5.92, 3.83); P = 0.67] and anticoagulation efficacy [OR = 2.64; 95% CI (0.41, 17.11); P = 0.31] were shown. No difference in the risk of bleeding events was shown [OR = 0.57; 95% CI (90.27, 1.21); P = 0.14]. The length of hospital stay in the NM group was significantly shortened [MD = –3.43; 95% CI (–5.53 to –1.33); P = 0.001]. NM showed significantly greater reduction in thrombin time (TT) compared to heparin [MD = –3.44; 95% CI (–5.33, –1.56); P = 0.0003), while no significant differences were observed in activated partial thromboplastin time (APTT) [MD = –5.35; 95% CI (–16.41, 5.72); P = 0.34) or international normalized ratio (INR) [MD = –0.46; 95% CI (–1.12, 0.20); P = 0.17].

NM demonstrates similar filter lifespan and bleeding safety to heparin in CRRT. NM may shorten hospital stay and differentially affects coagulation indicators, supporting its use in individualized anticoagulation. But because of poor evidence, the conclusions must be interpreted with caution.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251077749.