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Observational Study
. 2023 Jan 16;24(1):12.
doi: 10.1186/s12882-023-03060-1.

Unfractionated heparin versus nafamostat mesylate for anticoagulation during continuous kidney replacement therapy: an observational study

Shinya Kameda  1 , Tomoko Fujii  2 , Junpei Ikeda  3 , Akira Kageyama  4 , Toshishige Takagi  1 , Naoki Miyayama  1 , Kengo Asano  1 , Arata Endo  1 , Shoichi Uezono  5
Affiliations
Observational Study

Unfractionated heparin versus nafamostat mesylate for anticoagulation during continuous kidney replacement therapy: an observational study

Shinya Kameda et al. BMC Nephrol. .

Erratum in

Abstract

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.

Keywords: Acute kidney injury; Anticoagulant; Continuous kidney replacement therapy; Filter life; Nafamostat mesylate; Unfractionated heparin sodium.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The trend of acid–base profile. Red boxes, the NM group; green boxes, the UFH group. a. pH, b. base excess, c. bicarbonate, d. PaCO2, e. lactate, f. sodium, g. potassium, h. chloride
Fig. 2
Fig. 2
The probability of filter survival by the anticoagulant group plotted in the Kaplan–Meier curve
See this image and copyright information in PMC

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