Compared to nafamostat mesylate, unfractionated heparin was associated with a significantly longer filter life (mean difference 0.52 days) during continuous kidney replacement therapy.
Observational (n=286)
No
Does unfractionated heparin improve filter life compared to nafamostat mesylate in critically ill adult patients requiring continuous kidney replacement therapy?
In critically ill patients requiring continuous kidney replacement therapy, unfractionated heparin was associated with a significantly longer filter life compared to nafamostat mesylate.
Mean Difference: 0.52 (95% CI 0.15–0.89)
Absolute Event Rate: 1.58% vs 1.06%
p-value: p=0.006
BACKGROUND: Unfractionated heparin sodium and nafamostat mesylate have long been used as anticoagulants in continuous kidney replacement therapy (CKRT) where citrate is unavailable. This study aimed to determine whether heparin or nafamostat mesylate used during CKRT was associated with a longer filter life. METHODS: In this single-centre observational study, we included adult patients who required CKRT and used heparin or nafamostat mesylate for their first CKRT in the intensive care unit from September 1, 2013, to December 31, 2020. The primary outcome was filter life (from the start to the end of using the first filter). We used propensity score matching to adjust for the imbalance in patients' characteristics and laboratory data at the start of CKRT and compared the outcomes between the two groups. We also performed restricted mean survival time analysis to compare the filter survival times. RESULTS: We included 286 patients, 157 patients on heparin and 129 patients on nafamostat mesylate. After propensity score matching, the mean filter life with heparin was 1.58 days (N = 91, Standard deviation SD, 1.52) and with nafamostat mesylate was 1.06 days (N = 91, SD, 0.94, p = 0.006). Multivariable regression analysis adjusted for confounding factors supported that heparin was associated with a longer filter life compared with nafamostat mesylate (regression coefficient, days, 0.52 95% CI, 0.15, 0.89). The between group difference of the restricted mean filter survival time in the matched cohort was 0.29 (95% CI, 0.07-0.50, p = 0.008). CONCLUSION: Compared to nafamostat mesylate, heparin was associated with one-third to one-half a day longer filter life. TRIAL REGISTRATION: Not applicable.
Kameda et al. (Mon,) conducted a observational in Acute kidney injury requiring continuous kidney replacement therapy (n=286). Unfractionated heparin vs. Nafamostat mesylate was evaluated on Filter life (from the start to the end of using the first filter) (MD 0.52, 95% CI 0.15-0.89, p=0.006). Compared to nafamostat mesylate, unfractionated heparin was associated with a significantly longer filter life (mean difference 0.52 days) during continuous kidney replacement therapy.
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