Effect of nafamostat in continuous renal replacement therapy for patients at risk of bleeding

Objective To compare the effectiveness of heparin-protamine neutralization, or local citrate anticoagulation, and continuous infusion of nafamostat in continuous renal replacement therapy (CRRT) for patients at risk of bleeding. Methods A retrospective study was conducted on 65 patients with end-stage renal disease (ESRD) who received CRRT due to active bleeding or a tendency to bleed, from January 2018 to January 2024 at the Department of Nephrology, Taikang Xianlin Drum Tower Hospital and Nanjing Jiangbei Hospital. All patients received daytime CRRT with heparin-protamine neutralization, or local citrate anticoagulation, or continuous infusion of nafamostat. According to the anticoagulation regimen, the 65 ESRD patients were divided into three groups: 22 patients in group A received heparin-protamine neutralization, 22 patients in group B received local citrate anticoagulation, and 21 patients in group C received continuous infusion of nafamostat. Pre- and post-treatment electrolyte levels, liver function, blood creatinine, arterial blood gas, activated partial thromboplastin time (APTT), platelet count, and post-filter calcium ion changes were recorded. The occurrence of clotting in the filter and tubing was observed, and the base correction dose was calculated. Results There was no statistically significant difference in platelet count, alanine aminotransferase (ALT), and bilirubin levels among the three groups (P＞0.05). Post-treatment blood creatinine levels were significantly reduced in all three groups (P＜0.05), meeting the clinical requirements for daytime CRRT. There were statistically significant differences in APTT among the three groups (P＜0.05). In group C, APTT was prolonged post-treatment compared to pre-treatment (P＜0.05). Conclusion The use of three different anticoagulation methods in CRRT for patients at risk of bleeding shows that continuous infusion of nafamostat is simpler to operate, and results in fewer complications compared to heparin-protamine neutralization and local citrate anticoagulation.