Research Horizons


For Continuous Dialysis Nafamostat Shows Similar Efficacy, Lower Toxicity, Lower Costs vs. Citrate

A commonly-used dialysis anticoagulant in South Korea and Japan may eventually become an option for children in the US who need continuous renal replacement therapy (CRRT), a slower form of kidney dialysis that puts less strain on the heart.

A study published March 28, 2022  in Pediatric Nephrology compares nafamostat mesilate to regional citrate anticoagulation (RCA), which is commonly used in the EU and in the US under an Emergency Use Authorization.

Stuart Goldstein, MD, Director of the Center for Acute Care Nephrology at Cincinnati Children’s, was senior author. The study was supported by AcelRx, which has recently acquired the Lowell Therapeutics nafamostat asset to develop for use in any extracorporeal circuit.

A total of 158 patients were evaluated at sites in Japan and the US. Among the findings:

  • Median filter life was longer for nafamostat but once corrected for key variables, the two groups appeared similar regarding this outcome
  • No differences in major or minor bleeding rates were observed
  • Citrate toxicity occurred in 14% of patients, whereas no toxicity events with nafamostat occurred
  • Citrate anticoagulation is over 3 times the cost of nafamostat

Study limitations include that dialysis protocols varied to some degree between sites, the nafamostat patients on average were younger and smaller, and half the nafamostat patients were concomitantly undergoing plasmapheresis.

“Currently in the US, the safest option for regional anticoagulation in CRRT is the use of citrate,” Goldstein says. “These data demonstrate that both nafamostat and regional citrate can provide acceptable CRRT filter life with a low risk of bleeding events in patients who require CRRT.  Nafamostat has the added advantages of a simpler administration regimen for ICU staff, less risk of electrolyte derangement, no dependence on IV calcium or other reversal agents, as well as overall lowered costs to the hospital.”

Read more about the study

Publication Information
Original title: Comparison of Nafamostat Mesilate to Citrate Anticoagulation in Pediatric Continuous Kidney Replacement Therapy
Published in: Pediatric Nephrology
Publish date: March 28, 2022
Read the Study

Research By

Stuart Goldstein, MD
Director, Center for Acute Care Nephrology
My research is focused on short- and long-term outcomes for children who have AKI and those who are at risk for AKI.