Effects of Nafamostat Mesilate and Systemic Unfractionated Heparin Anticoagulation on Coagulation, Renal Function, and 28-day Survival Status in Critically Ill AKI CRRT Patients.

Abstract

Introduction: To investigate the effect of continuous renal replacement therapy (CRRT) in patients with severe acute kidney injury (AKI) by using Nafamostat Mesilate (NM).  Methods. Eighty patients with AKI who underwent CRRT from March 2022 to January 2022 were divided into control group (n = 40, treated with unfractionated heparin) and Observation group (n = 40, treated with NM). The duration of the first filter use, the number of filters used 72 hours after treatment, coagulation and renal functions, adverse reactions, bleeding events, length of stay in intensive care unit (ICU) and survival status at 28 days were compared between the two groups.  Results. The observation group used the first filter for a longer period of time than the control group, and after 72 hours of treatment, the number of filters used was less than that of the control group (P < .05); Compared with before treatment, the levels of fibrinogen (FIB) and platelet count (PLT) in the observation group and control group decreased after 48 hours of treatment, while the levels of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and international normalized ratio (INR) increased. However, the levels of FIB and PLT in the former group were higher, while the levels of APTT, PT, TT, and INR were lower (P < .05); Compared with before treatment, the levels of creatinine (Scr), urea nitrogen (BUN), and serum cystatin C (CysC) in the observation group and control group decreased after 48 hours of treatment, and the former was even lower (P < .05); the incidence of bleeding events in the observation group was lower than that in the control group, the length of stay in ICU was shorter than that in the control group, and finally the 28-day survival rate was higher than that in the control group (P < .05). The adverse reactions of the two groups were similar (P > .05).

Conclusions: NM can improve the coagulation function and renal function in patients with severe AKI undergoing CRRT, prolong the duration of the filter use, reduce the number of filters used, shorten the length of ICU stay, reduce the incidence of bleeding events, and improve the prognosis.