Effect of extracorporeal anticoagulation with nafamostat mesilate and continuous renal replacement therapy in sepsis complicated by acute kidney injury.

OBJECTIVE

We aimed to evaluate the effect of extracorporeal anticoagulation with nafamostat mesilate (NM) and continuous renal replacement therapy (CRRT) on sepsis complicated with acute kidney injury (AKI).

MATERIALS AND

METHODS

The clinical data of 106 sepsis patients complicated with AKI admitted from January 2023 to December 2024 were retrospectively analyzed. According to different treatment protocols, the patients were assigned into a control group (n = 53, regional citrate anticoagulation (RCA) plus CRRT) and a study group (n = 53, NM extracorporeal anticoagulation plus CRRT). The use of extracorporeal circulation circuit was compared.

RESULTS

After 3 days of treatment, the levels of procalcitonin, interleukin-6, and tumor necrosis factor-α decreased in the two groups compared to those before treatment (p < 0.05), and they were lower in the study group than in the control group (p < 0.05). After 3 days of treatment, both groups had lowered levels of serum creatinine (Scr), cystatin C (Cys-C), and blood urea nitrogen (BUN), together with increased mean transit time (MTT), peak intensity (PI), and area under the curve (AUC) compared with those before treatment. In the study group, the levels of Scr, Cys-C, and BUN declined, while MTT, PI, and AUC rose compared with those in the control group (p < 0.05). The incidence of adverse reactions in the study group was lower than that in the control group (3.77 vs. 16.98%) (p &lt; 0.05).

CONCLUSION

NM outperforms RCA in prolonging the hemofilter lifespan, reducing hemofilter replacement frequency, improving renal perfusion and renal function, and eliminating inflammatory mediators.