AN69ST membranes adsorb nafamostat mesylate and affect the management of anticoagulant therapy: a retrospective study

Takahiro Hirayama,Yasumasa Okawa,Atsunori Nakao,Toshiaki Sendo,Nobuyuki Nosaka,Yoshihisa Kitamura,Toyomu Ugawa,Soichiro Ushio

doi:10.1186/s40560-017-0244-x

Takahiro Hirayama, Yasumasa Okawa + Show 6 more

Open Access

https://doi.org/10.1186/s40560-017-0244-x

Copy DOI

Abstract

BackgroundIn Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT). The dialyzer membrane AN69ST has been reported to adsorb NM and affect the management of anticoagulant therapy. However, the adsorbed amount has not yet been quantitatively assessed. Therefore, in this study, we evaluated the pre- and post-hemofilter prolongation of the activated clotting time (ACT) in patients with AN69ST and PS membranes. We also measured the adsorption of NM in three types of CRRT membranes using an experimental model.MethodsIn a study of patients who underwent CRRT using AN69ST or PS membranes in 2015 at the Advanced Emergency and Critical Care Center, Okayama University Hospital, pre- and post-hemofilter ACT measurements were extracted retrospectively, and the difference was calculated. In addition, AN69ST (sepXiris100), PS (HEMOFEEL SHG-1.0), and PMMA membranes (HEMOFEEL CH-1.0N) were used in an in vitro model of a dialysis circuit, and the concentrations of NM were measured in pre- and post-hemofilter membranes and filtrates.ResultsThe ACT difference was significantly lower in the group using AN69ST membranes (p < 0.01). In the in vitro model (n = 4) with adsorption and filtration, the post-hemofilter and filtrate concentrations of NM in AN69ST membranes were significantly lower than those in the PS and PMMA membranes (p < 0.01). The NM adsorption clearance of the AN69ST membrane was significantly higher than that of the PS and PMMA membranes.ConclusionsThe AN69ST membrane had higher NM adsorption than the PS and PMMA membranes. This may have resulted in the lower ACT difference in patients undergoing CRRT using the AN69ST membrane than in patients undergoing CRRT using PS or PMMA membranes.

Highlights

In Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT)
The difference in activated clotting time (ACT) was significantly lower with the AN69ST membrane There were 122 and 37 ACT measurements in 19 AN69ST-treated patients and 11 PS-treated patients, respectively
The ACT difference was significantly lower in the AN69ST membrane group (p < 0.01)

Summary

Introduction

In Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT). The dialyzer membrane AN69ST has been reported to adsorb NM and affect the management of anticoagulant therapy. In this study, we evaluated the pre- and post-hemofilter prolongation of the activated clotting time (ACT) in patients with AN69ST and PS membranes. Continuous renal replacement therapy (CRRT) has a milder impact on hemodynamics than intermittent hemodialysis therapy and enables strict management of the body fluid balance, acid-base equilibrium, electrolytes, and plasma osmotic pressure. In Japan, nafamostat mesylate (NM) is used in most patients receiving CRRT because it does not affect the patient’s coagulability in vivo [3]. NM exerts anticoagulant effects only in extracorporeal circulation circuits, whereas in vivo, NM is quickly inactivated, enabling safe management of coagulation [4]

Methods

Results

Discussion

Conclusion