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Abstract: PO1960

Comparison of Nafamostat Mesylate and Regional Citrate Anticoagulation in Pediatric CRRT Anticoagulation

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Miyaji, Mai J., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Ide, Kentaro, Kokuritsu Kenkyu Kaihatsu Hojin Kokuritsu Seiiku Iryo Kenkyu Center, Setagaya-ku, Tokyo, Japan
  • Takashima, Kohei, Shiga Ika Daigaku, Otsu, Shiga, Japan
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Regional Citrate Anticoagulation (RCA) is the preferred CRRT anticoagulation strategy for children in the US. Nafamostat Mesilate (NM), a synthetic serine protease, has been used widely for CRRT anticoagulation (ACG) in Japan and Korea. While NM is considered safe and effective, there is a paucity of evidence in pediatric CRRT. We compare the safety and efficacy of NM to RCA for pediatric CRRT.

Methods

Using one pediatric hospital in Japan and one in the US, medical records of patients (pts) <21 years of age on CRRT between 2016-2019 were reviewed, excluding pts receiving CRRT with ECMO. Pt demographics, CRRT characteristics, and outcomes were compared between RCA and NM groups. Filter life (FL), defined as the number of hours a single CRRT filter was in use, was the primary outcome. Safety is assessed by bleeding complications.

Results

76 pts (248 filters) received RCA and 89 pts (226 filters) received NM. Baseline characteristics are shown Table 1. RCA pts were older and received higher Qb. Median FL (hours) did not differ by ACG type (RCA: 35 [16,67] vs. NM: 38 [22,68]. The lack of difference in FL between groups persisted when controlling for pt age and CRRT Qb.

Conclusion

RCA and NM are safe and appear to be equally effective ACG for children receiving CRRT. A prospective randomized trial is required to validate these findings.

Patient Demographics/OutcomeRCA(N=76)NM (N=89)p-value
Age [yrs; median (IQR)]8 (1.8-16)1.3 (0.6-5)<0.001
Most common diseaseKidney (55.3%)Liver disease (27.0%)<0.001
systemic
bleeding, n (%)
7 (9.2)4 (4.5)0.334
Filter DataRCA (N=248)NM (N=226)p-value
FL [hours; median (IQR)]34.9 (16.4-66.5)37.7 (21.7-69.4)0.646
Mode of CRRTCVVHDF (96.4%)CVVHDF (38.9%)
CVVHD (42.9%)
<0.001
Qb[ml/min: median (IQR)]100 (60-150)50 (30-70)<0.001