Clinical Report: Evaluating Nafamostat Mesylate vs Citrate in CRRT

Overview

This systematic review and meta-analysis compares the safety and effectiveness of nafamostat mesylate (NM) and citrate for anticoagulation in continuous renal replacement therapy (CRRT). NM demonstrated a lower risk of bleeding events compared to citrate, while showing comparable filter lifespan and clotting events.

Background

Anticoagulation is crucial for the success of continuous renal replacement therapy (CRRT), particularly in critically ill patients with acute kidney injury. Traditional anticoagulants like unfractionated heparin carry significant bleeding risks, prompting the need for safer alternatives. Nafamostat mesylate (NM) has emerged as a potential option, especially for patients with contraindications to citrate.

Data Highlights

Key Findings

• No significant differences in filter lifespan or clotting events between NM and citrate.
• NM reduced the risk of bleeding events compared to citrate (RR = 0.54, p = 0.003).
• Subgroup analyses indicated NM was associated with lower bleeding risk in high-risk bleeding patients.
• No significant differences in platelet count, APTT, or PT between NM and citrate.
• The overall certainty of evidence from this study is low to very low.

Clinical Implications

Clinicians should consider the overall low certainty of evidence when evaluating the use of nafamostat mesylate in CRRT.

Conclusion

Nafamostat mesylate shows comparable anticoagulant efficacy to citrate in CRRT with a lower risk of bleeding. Further high-quality randomized controlled trials are needed to confirm these findings.

Related Resources & Content

1. Critical Care (Springer), 2026 -- Nafamostat Mesilate as an Anticoagulant in Blood Purification: A Comprehensive Review and Meta-Analysis
2. KDIGO, 2026 -- KDIGO 2026 Clinical Practice Guideline for AKI/AKD
3. Clinical Research in Cardiology — Evaluating the Effectiveness and Safety of Direct Oral Anticoagulants Versus Vitamin K Antagonists in Dialysis Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
4. Critical Care (Springer) — Incidence, severity, and predictors of citrate accumulation during continuous kidney replacement therapy in the critically ill
5. Critical Care (Springer) — Identifying Key Factors Influencing Citrate Build-Up in Continuous Kidney Replacement Therapy: The Impact of Citrate Concentration and Dilution Techniques
6. Nafamostat mesilate as anticoagulant for blood purification: a systematic review and meta-analysis
7. Topic
8. Korean Society of Nephrology 2025 Evidence-Based Clinical Practice Guideline for Continuous Kidney Replacement Therapy - PMC
9. Frontiers | Comparing the efficacy and safety of nafamostat mesylate versus citrate for anticoagulation in continuous renal replacement therapy: a systematic review and meta-analysis
10. Nafamostat mesylate versus regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding: a retrospective single-center study | European Journal of Medical Research | Springer Nature Link
11. Dose of nafamostat mesylate during continuous kidney replacement therapy in critically ill patients: a two-centre observational study | BMC Nephrology | Springer Nature Link