TITLE:
Evaluation of the Pharmacokinetics of Nafamostat Mesylate during Continuous Renal Replacement Therapy
AUTHORS:
Koji Konishi, Satoki Inoue, Masahiko Kawaguchi
KEYWORDS:
Nafamostat Mesylate, Continuous Renal Replacement Therapy, Liver Dysfunction
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.10 No.4,
October
25,
2022
ABSTRACT: Continuous
renal replacement therapy (CRRT) is the preferred dialysis modality in critical
care settings for patients with hemodynamic instability. Nafamostat mesylate
(NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in
patients with high bleeding risk. In this study, we evaluated the
pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using
NM as the anticoagulant in the intensive care unit were enrolled in the study.
Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the
filtrates after the membrane. NM concentrations were measured using
high-performance liquid chromatography. NM was detected in the intracorporeal
circulation during CRRT in some cases, and liver enzymes were severely elevated
in almost all of the cases. Coagulation time was prolonged even before the
initiation of NM administration in these cases and may be associated with liver
damage. This study suggests that NM dosage should take into account liver
damage assessed by elevated liver enzymes.