Safety and efficacy of nafamostat mesylate as extracorporeal anticoagulation during continuous renal replacement therapy in uremic patients

doi:10.3969/j.issn.1004-583X.2026.03.007

Abstract

Abstract:

Objective To evaluate the safety and efficacy of nafamostat mesylate (NM) as an extracorporeal anticoagulant in critically ill uremic patients undergoing continuous renal replacement therapy (CRRT). Methods From July 2024 to August 2025, 58 patients who received CRRT in the Nephrology Department of Beijing Shijingshan Hospital were enrolled and randomized into an NM group (observation group) and a heparin sodium injection group (control group). Activated partial thromboplastin time (APTT), platelet count (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and serum potassium (K) were measured at different time points and at three blood-sampling sites (A, B, C) and analyzed statistically. Filter lifespan and adverse events including hemorrhage and allergy were recorded to comprehensively assess the safety and efficacy of NM during CRRT. Results ① Baseline characteristics were comparable between the two groups (P>0.05). ② Anticoagulation efficacy was similar between groups, with no statistically significant difference (P>0.05). ③ In the NM group, APTT measured at site A at different time points did not differ significantly from APTT measured at site C at 15 min after CRRT termination (P>0.05). ④ In the NM group, comparisons between site A at CRRT 0 h and site C at 15 min after CRRT termination showed no significant differences for PLT, ALT, or AST (P>0.05); however, serum K differed significantly (P<0.05). ⑤ Between the two groups, APTT at site A at CRRT 4 h and at CRRT termination differed significantly (P<0.05), whereas APTT at site B showed no significant differences across time points (P>0.05). ⑥ At site C, 15 min after CRRT termination, PLT differed significantly between groups (P<0.05), while serum potassium and transaminases showed no significant differences (P>0.05). ⑦ The incidence of hemorrhage differed significantly between the two groups (P<0.05). ⑧ The overall incidence of adverse reactions did not differ significantly between groups (P>0.05). Conclusion Intravenous nafamostat mesylate provides effective extracorporeal anticoagulation during CRRT with minimal systemic impact on coagulation parameters, a low rate of adverse reactions, and good safety.

Key words: continuous renal replacement therapy, intravenous nafamostat mesylate, uremia, anticoagulation

CLC Number:

R459.5

Shao Surong, Guo Yan. Safety and efficacy of nafamostat mesylate as extracorporeal anticoagulation during continuous renal replacement therapy in uremic patients[J]. Clinical Focus, 2026, 41(3): 235-240.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.03.007

https://www.lchc.cn/EN/Y2026/V41/I3/235

Figures/Tables 9

References 15

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项目	观察组(n=29)	对照组(n=29)	t/χ²值	P值
年龄(岁)	64.00±9.81	64.10±9.66	-0.040	0.968
男性[例(%)]	17(58.6)	16(55.2)	-0.261	0.795
APTT(s)	27.17±1.64	28.27±3.00	-1.742	0.089
PLT(×10⁹/L)	165.38±51.75	167.10±64.27	-1.113	0.911
血K(mmol/L)	4.82±0.72	5.08±0.72	-1.329	0.189
ALT(U/L)	19.83±7.53	18.48±10.38	0.565	0.575
AST(U/L)	20.41±7.72	19.55±9.01	2.661	0.060
原发病[例(%)]
糖尿病性肾病	10(34.48)	11(37.93)	0.075	0.785
慢性肾小球肾炎	12(41.38)	10(34.48)	0.293	0.588
高血压性肾病	4(13.79)	6(20.69)	0.483	0.487
其他	3(10.35)	2(6.90)	0.345	0.557

项目	观察组(n=29)	对照组(n=29)	t/χ²值	P值
年龄(岁)	64.00±9.81	64.10±9.66	-0.040	0.968
男性[例(%)]	17(58.6)	16(55.2)	-0.261	0.795
APTT(s)	27.17±1.64	28.27±3.00	-1.742	0.089
PLT(×10⁹/L)	165.38±51.75	167.10±64.27	-1.113	0.911
血K(mmol/L)	4.82±0.72	5.08±0.72	-1.329	0.189
ALT(U/L)	19.83±7.53	18.48±10.38	0.565	0.575
AST(U/L)	20.41±7.72	19.55±9.01	2.661	0.060
原发病[例(%)]
糖尿病性肾病	10(34.48)	11(37.93)	0.075	0.785
慢性肾小球肾炎	12(41.38)	10(34.48)	0.293	0.588
高血压性肾病	4(13.79)	6(20.69)	0.483	0.487
其他	3(10.35)	2(6.90)	0.345	0.557

组别	例数	0级	Ⅰ级	Ⅱ级	Ⅲ级	抗凝有效率
观察组	29	25(86.2)	2(6.9)	2(6.9)	0	27(93.1)
对照组	29	25(86.2)	3(10.3)	1(3.5)	0	28(96.6)
χ²值						0.352
P值						0.553

组别	例数	0级	Ⅰ级	Ⅱ级	Ⅲ级	抗凝有效率
观察组	29	25(86.2)	2(6.9)	2(6.9)	0	27(93.1)
对照组	29	25(86.2)	3(10.3)	1(3.5)	0	28(96.6)
χ²值						0.352
P值						0.553

变量	A采血点			C采血点血滤结束15 min	F值	P值
变量	CRRT 0 h	CRRT 4 h	CRRT结束	C采血点血滤结束15 min	F值	P值
APTT(s)	27.16±1.64	27.77±1.93	28.85±2.44	27.73±2.74	2.901	0.061