Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH, 45229, USA.
Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Nephrol. 2022 Nov;37(11):2733-2742. doi: 10.1007/s00467-022-05502-8. Epub 2022 Mar 28.
Regional citrate anticoagulation (RCA) is the preferred continuous kidney replacement therapy (CKRT) anticoagulation strategy for children in the USA. Nafamostat mesilate (NM), a synthetic serine protease, is used widely for CKRT anticoagulation in Japan and Korea. We compared the safety and efficacy of NM to RCA for pediatric CKRT.
Starting June 2019, the most recent 100 medical records of children receiving CKRT with either RCA or NM were reviewed retrospectively, at one children's hospital in Japan (NM) and one in the USA (RCA). The number of hours a single CKRT filter was in use, was the primary outcome. Safety was assessed by bleeding complications for the NM group and citrate toxicity leading to RCA discontinuation or electrolyte imbalance in the RCA group.
Eighty patients received NM and 78 patients received RCA. Median filter life was longer for the NM group (NM: 38 [22, 74] vs. RCA: 36 [17, 66] h, p = 0.02). When filter life was censored for discontinuation other than clotting, the 60-h survival rate was higher for RCA (71% vs. 54%). The hazard ratio comparing NM over RCA varied over time (HR 0.7; 0.2-1.5, p = 0.33 at 0 h to HR 5.5; 1.3-23.7, p = 0.334 at 72 h). The lack of difference in filter survival persisted controlling for filter surface area, catheter diameter, and pre-CKRT platelet count. Major bleeding rates did not differ between groups (NM: 5% vs. RCA: 9%).
RCA and NM provide satisfactory anticoagulation for CKRT in children with no difference in major bleeding rates. A higher resolution version of the Graphical abstract is available as Supplementary information.
区域枸橼酸抗凝（RCA）是美国儿童首选的连续肾脏替代治疗（CKRT）抗凝策略。那屈肝素钙（NM），一种合成丝氨酸蛋白酶，在日本和韩国广泛用于 CKRT 抗凝。我们比较了 NM 和 RCA 用于儿科 CKRT 的安全性和有效性。
从 2019 年 6 月开始，回顾性分析了日本（NM）和美国（RCA）的一家儿童医院最近的 100 例接受 RCA 或 NM 治疗的儿童 CKRT 的病历。单次 CKRT 过滤器的使用时间是主要结局。NM 组评估出血并发症的安全性，RCA 组评估枸橼酸盐毒性导致 RCA 停止或电解质失衡的安全性。
80 例患者接受 NM 治疗，78 例患者接受 RCA 治疗。NM 组过滤器寿命中位数较长（NM：38 [22，74] vs. RCA：36 [17，66] h，p = 0.02）。当排除除凝血外的其他原因导致的停止使用时，RCA 组 60 h 生存率更高（71% vs. 54%）。比较 NM 与 RCA 的时间依赖性危险比（HR）随时间变化（0 h 时 HR 0.7；0.2-1.5，p = 0.33 到 72 h 时 HR 5.5；1.3-23.7，p = 0.334）。在控制过滤器表面积、导管直径和 CKRT 前血小板计数后，过滤器存活率的差异仍然存在。两组之间主要出血率无差异（NM：5% vs. RCA：9%）。
RCA 和 NM 为儿童 CKRT 提供了令人满意的抗凝效果，两组之间主要出血率无差异。更清晰的图表版本可以在补充信息中查看。
