The following is a summary of “Dose of nafamostat mesylate during continuous kidney replacement therapy in critically ill patients: a two-center observational study,” published in the February 2024 issue of Nephrology by Kameda et al.
Nafamostat mesylate, employed as an anticoagulant in critically ill patients undergoing continuous kidney replacement therapy (CKRT), is distinguished by its brief half-life, yet its ideal dosage remains uncertain.
Researchers conducted a retrospective study to investigate the most effective dosage of nafamostat mesylate in CKRT.
They carried out a two-center observational study, screening all critically ill adult patients requiring CKRT in the ICU (September 2013- August 2021). Inclusion criteria comprised patients aged ≥ 18 years who received nafamostat mesylate during CKRT. The primary outcome, filter life, defined as the duration from CKRT initiation to the first filter change due to clotting, was assessed alongside secondary outcomes, including safety and additional clinical parameters. Survival analysis of filter patency based on nafamostat mesylate dosage, adjusted for bleeding risk and hemofiltration, was conducted using a Cox proportional hazards model.
The results indicated that among the 269 patients, the mean dosage of nafamostat mesylate was 15.8 mg/hr (SD, 8.8; Range, 5.0 to 30.0). The median filter life was determined to be 18.3 hours (IQR, 9.28 to 36.7). Upon conducting filter survival analysis, no significant association was observed between filter life and nafamostat mesylate dosage (HR 1.12; 95% CI 0.74–1.69, P=0.60) after adjusting for bleeding risk and incorporating the use of haemofiltration in conjunction with hemodialysis.
Investigators concluded that Nafamostat mesylate at varying doses (5-30 mg/h) during CKRT in critically ill patients did not show a dose-dependent effect on filter life, warranting further investigation for optimal dosage in randomized controlled trials.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03506-0