Efficacy and safety of nafamostat mesilate in pediatric continuous renal replacement therapy: a 5-year retrospective study in South Korea

Purpose: This study aimed to evaluate the efficacy and safety of a nafamostat mesilate (NM) protocol in pediatric patients undergoing continuous renal replacement therapy (CRRT).Methods: A retrospective review was performed in 107 patients who underwent at least 24 hours of CRRT between January 2018 and December 2022 at Samsung Medical Center. According to the anticoagulation strategy used during CRRT, patients were categorized into three groups: no anticoagulation (Group 1), NM (Group 2), and heparin (Group 3).Results: A total of 107 patients (mean age 7.8±5.5 years) were included. The mean duration of CRRT was 11.7 days, and the overall survival rate was 61.7%. NM and heparin were administered to 38 and 27 patients, respectively, whereas 42 patients received no anticoagulant therapy. Mean filter life did not differ significantly among the groups (no anticoagulation 32.1 hours vs. NM 26.7 hours vs. heparin 33.9 hours; P=0.092). However, among 11 patients in the NM group who initiated NM during ongoing CRRT because of inadequate filter lifespan without anticoagulation, hemofilter lifespan significantly increased from 19.8±7.7 to 27.0±9.4 hours after NM initiation (P=0.030). No known complications associated with NM use were observed. One patient experienced minor bleeding at the peritoneal dialysis catheter site during heparin administration. Survival rates did not differ significantly among the groups.Conclusions: NM appears to be a safe anticoagulation option in pediatric CRRT patients at high bleeding risk. While overall filter life was comparable across groups, NM significantly prolonged hemofilter lifespan in patients switched from no anticoagulation, supporting its potential role as a rescue strategy.