Usage of nafamostat mesylate during continuous renal replacement therapy and filter life: a scoping review

Abstract

Background: Acute kidney injury is common in ICUs; however, it lacks established treatments, often requiring continuous renal replacement therapy (CRRT). The extracorporeal circulation is prone to blood coagulation, leading to treatment interruptions and reduced efficiency. Nafamostat mesylate is widely used in Japan for its anticoagulant properties and a short half-life, suggesting reduced bleeding risks. However, its optimal use in critically ill patients remain unclear. Methods: A scoping review was performed to summarise comprehensively about using nafamostat mesylate during CRRT and its effects on filter life. MEDLINE, Embase, Cochrane EBM Reviews, and ICHUSHI were searched in December 2023. It included studies reporting on filter life if using nafamostat for CRRT anticoagulation in any forms of reports, including original data. Screening was performed independently by two researchers, based on titles and abstracts, followed by full-text reviews to finalise the selection. Study characteristics and details on using nafamostat were collected. Results: Of 357 records screened, 32 studies were eligible, most being observational studies. Nafamostat doses reportedly ranged from 10–40 mg/hr, with the majority around 30 mg/hr. Eleven studies reported activated clotting time (ACT) values, with seven adjusting nafamostat doses accordingly. Target ACT levels varied widely, with some studies maintaining a fixed dose. Filter life spanned from 11.8–54.6 hr, with a weighted average of 34.1 hr. Hemorrhagic complications’ rate during CRRT ranged 0–6.6% for filter numbers, and high transfusion rates were noted. Conclusions: In using nafamostat as an anticoagulant during CRRT, filters typically last approximately 34 hours on average. Doses varied, with most studies monitoring anticoagulant function with ACT. However, patient characteristics and membrane selection may influence filter life. The findings suggest a need for further research to standardise the optimal use of nafamostat during CRRT.