- Design
- Meta-analysis of 8 studies, predominantly non-randomised
- Population
- 1,189 patients receiving continuous kidney replacement therapy
- Primary outcome
- Mortality, filter lifespan and bleeding
- Effect
- Filter life mean difference 7.0 (95% CI 1.5–12.5); mortality OR 0.58 (0.44–0.76); bleeding OR 1.09 (0.51–2.34)
This meta-analysis pooled eight studies with 1,189 patients receiving continuous kidney replacement therapy, comparing nafamostat mesilate with no anticoagulation. Most studies were non-randomised.
Nafamostat was associated with longer filter life (mean difference 7.0) and lower mortality (OR 0.58). Bleeding complications, transfusion need, CRRT duration and ICU stay did not differ significantly.
Nafamostat is a short-acting serine protease inhibitor used as a regional anticoagulant in parts of Asia for patients at high bleeding risk, where heparin is avoided and citrate is impractical. Longer filter life means less downtime and fewer interruptions in clearance.
The mortality association is not credible as a drug effect: patients given no anticoagulation are usually sicker or bleeding, which confounds the comparison. The filter-life finding is more plausible but also heterogeneous. Availability and cost in India are not established here.
- Consider regional anticoagulation options for CRRT in patients at high bleeding risk, following unit protocol.
- Use regional citrate where available and protocolised, as the commonly recommended first choice.
- Track filter life as a unit quality measure; frequent clotting means lost treatment time.
- Do not cite these data as evidence that nafamostat reduces mortality.
Why it matters
Filter clotting in patients who cannot take heparin is a daily ICU problem with few good options.
Don't overread it
Mostly non-randomised; it does not show that nafamostat saves lives.
The statistics, in plain English
An odds ratio of 0.58 for mortality looks large, but in non-randomised studies the comparison group (no anticoagulation) is likely to be sicker. Heterogeneity was substantial, so the pooled estimates are uncertain.
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