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

Objectives To determine the safety and effectiveness of the anticoagulation regimen nafamostat mesylate for continuous renal replacement therapy in patients with sepsis-associated AKI. Methods 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. Results 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. Conclusions The anticoagulation regimen of nafamostat mesylate may be safe and effective in patients with sepsis-associated AKI receiving CRRT.