Meta-analysis of the effect of nafamostat mesilate versus no-anticoagulation regimens in adult patients undergoing continuous renal replacement therapy

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• Picked for Critical Care and Intensive Care Medicine (paper of the day, 6 November 2026): Compares anticoagulation strategies during ICU renal replacement

Abstract

BACKGROUND: Continuous renal replacement therapy (CRRT) is a critical treatment for critically ill patients with acute kidney injury. However, effective anticoagulation of the extracorporeal circuit remains a clinical challenge. Nafamostat mesilate (NM), a serine protease inhibitor, possesses localized anticoagulation properties; however, its efficacy and safety in high-bleeding-risk populations have not been systematically evaluated. OBJECTIVE: To compare the efficacy and safety of NM anticoagulation and no-anticoagulation regimens in patients undergoing CRRT. METHODS: Randomized controlled trials (RCTs) and cohort studies were retrieved from PubMed, Web of Science, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Wanfang Database, Chinese National Knowledge Infrastructure, and the Chinese Biomedical Literature Database. We included studies on adult patients receiving CRRT where the intervention and control groups were treated with NM anticoagulation and no-anticoagulation regimens, respectively. Primary outcomes included filter lifespan, number of filters used, coagulation indicators, bleeding events, and in-hospital mortality. The meta-analysis was conducted using RevMan 5.4 software. RESULTS: Eight studies involving 969 patients were included. The meta-analysis demonstrated that, compared with the control group, the NM group had a significantly prolonged filter lifespan (P = 0.01) and a reduced number of filters used (P < 0.0001). The activated partial thromboplastin time (P = 0.89), prothrombin time (P = 0.88), and international normalized ratio (P = 0.60) showed no significant differences. Both groups demonstrated clinically similar risks of bleeding events (P = 0.53). However, the NM group demonstrated a significantly reduced in-hospital mortality, compared with the control group (P = 0.02). CONCLUSION: The NM anticoagulation regimen effectively extended the CRRT filter lifespan, reduced resource consumption, and improved patient survival outcomes without increasing the bleeding risk, demonstrating particular value for high-bleeding-risk populations. Future multicenter RCTs are warranted to validate applicability of NM in non-East Asian populations. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399024, identifier: PROSPERO CRD420251077578.

Abstract as published, via PubMed.