Objective:

To systematically compare the efficacy and safety of nafamostat mesylate (NM) versus citrate for anticoagulation in continuous renal replacement therapy (CRRT).

Approach:

• Literature Search: Comprehensive search in multiple databases including PubMed, Web of Science, Embase, Cochrane Library, and others.
• Data Extraction and Quality Assessment: Conducted by two researchers using standardized procedures and double-blinded methods.
• Statistical Analysis: Performed using Review Manager V.5.4 and STATA 15.1, assessing statistical heterogeneity and publication bias.

Key Findings:

• A total of 18 studies involving 2,247 CRRT patient episodes were included. The meta-analysis showed no significant differences in filter lifespan or clotting events between NM and citrate (MD = −0.11, 95%CI: −1.87 to 1.65, p = 0.90; RR = 0.63, 95%CI: 0.25–1.59, p = 0.33). NM reduced the risk of bleeding events compared with citrate (RR = 0.54, 95%CI: 0.36–0.82, p = 0.003). Subgroup analyses indicated NM was associated with a lower risk of bleeding in high-risk situations and low-dose NM (RR = 0.47, 95%CI: 0.25–0.88, p = 0.02; RR = 0.39, 95%CI: 0.23–0.66, p < 0.001).

Interpretation:

The findings suggest comparable anticoagulant efficacy between NM and citrate in CRRT, with a lower risk of bleeding in specific high-risk situations.

Limitations:

• Overall certainty of the evidence is low to very low.
• Further multi-center, large-sample, high-quality RCTs are required to validate findings.

Conclusion:

For CRRT patients with contraindications to citrate or high bleeding risk, NM may be an alternative anticoagulant.

Sources:

• Systematic Review Registration