Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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The Use of Nafamostat Mesilate as an Anticoagulant during Continuous Renal Replacement Therapy for Children with a High Risk of Bleeding

출혈성 경향이 높은 소아환자의 지속성 신대체 요법시 사용되는 항응고제로서 Nafamostat mesilate의 사용

  • Lee, Sang Taek (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Heeyeon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 이상택 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 조희연 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Received : 2014.06.05
  • Accepted : 2014.09.20
  • Published : 2014.10.31
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Abstract

Purpose: Nafamostat mesilate (NM), a synthetic serine protease inhibitor, has been investigated as an anticoagulant for adult patients with a high risk of bleeding, who need chronic renal replacement therapy (CRRT). However, little is known about the use of NM as an anticoagulant in pediatric CRRT. The aim of this study was to evaluate the ideal dosage, efficacy, and safety of NM in pediatric CRRT. Methods: We conducted a retrospective study of 40 pediatric patients who had undergone at least 24 h of venovenous CRRTs between January 2011 and October 2013. We divided the patients according to risk of bleeding. Those at high risk received no anticoagulation (group 1) or NM as an anticoagulant (group 2), while those at low risk received heparin (group 3). Results: Forty patients (25 male and 15 female; mean age, $8.2{\pm}6.6$ years) were enrolled. The mean duration of CRRT was 13.0 days, and the survival rate was 57.5%. The mean hemofilter lifespan was 39.3 h in group 1 and 11.3 h in group 3. In group 2, hemofilter lifespan was extended from 7.5 h to 27.4 h after the use of NM (P =0.001). The mean hemofilter lifespan with NM was greater than with heparin (P =0.018). No patient experienced a major bleeding event during treatment with NM. Conclusion: NM may be a good alternative anticoagulant in pediatric patients with a high risk of bleeding requiring CRRT, and is not associated with bleeding complications.

목적: Nafamostat mesilate는 출혈성 경향이 있는 성인 환자에서 지속적 신대체 요법시 항응고제로 사용되고 있지만 소아에서의 경험은 잘 알려지지 않았다. 본 연구는 출혈 성향이 높은 소아에서 지속적 신대체 요법을 시행하는 경우에 항응고제로서 Nafamostat mesilate의 용량, 효과, 및 안전성에 대하여 알아보기 위해 수행하였다. 방법: 2011년 1월부터 2013년 10월까지 최소 24시간이상 지속적신대체요법을 받은 40명의 소아환자들을 대상으로 하여 의무기록을 후향적으로 분석하였다. 환자들은 출혈 위험군(그룹 1: 항응고제 사용 안함, 그룹 2: 항응고제로 Nafamostat mesilate 사용)과 출혈 위험이 없는 군(그룹 3: 항응고제로 헤파린 사용)으로 분류하였다. 결과: 40명의 환자 중에서 남아는 25명 여아는 15명 이었으며 평균 나이는 $8.2{\pm}6.6$세 이었다. 지속적신대체요법의 평균 시간은 13일 이었다. 평균 혈액 필터 수명은 그룹 1에서는 39.3시간 이었고, 그룹 3에서는 11.3시간이었다. 그룹 2에서는 Nafamostat mesilate 사용 전에는 7.5시간 이었으나 Nafamostat mesilate 사용 후에는 27.4시간으로 연장되었으며 통계학적으로 유의하였다(P=0.001). 평균 혈액 필터 수명은 Nafamostat mesilate을 사용한 그룹에서는 헤파린을 사용한 그룹보다 통계적으로 의미 있게 연장되었다(P=0.018). Nafamostat mesilate 사용한 군에서 의미있는 출혈이 동반되지는 않았다. 결론: Nafamostat mesilate은 출혈 성향이 높은 소아에서 지속적 신대체 요법을 시행하는 경우에 헤파린을 대체해서 사용될 수 있는 항응고제로 생각된다.

Keywords

References

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