ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Renal Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1592562
Application of Nafamostat Mesylate in 5 Cases of Extracorporeal Carbon Dioxide Removal Combined with Continuous Renal Replacement Therapy
Provisionally accepted
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Objective: To explore the application of nafamostat mesylate in the ECCO2R combined with CRRT. Method: We analyzed the cases of 5 patients who underwent ECCO2R combined with CRRT due to severe hypercapnia with acute kidney injury at the Blood Purification Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2023 to October 2024. The treatments were performed using the OMNI blood purification system, equipped with a PMP polymethylpentene membrane lung, with unhumidified pure oxygen connected to the ECCO2R membrane lung via an oxygen supply device at a rate of 6-7L/min, and in series with the blood filter. CRRT was performed using the CVVH mode, with sodium lactate replacement fluid at a flow rate of 2-3L/h. The extracorporeal blood flow was maintained between 300-400ml/min. Continuous infusion of NM (50-30mg/h) was used to maintain anticoagulation. Demographic and physiological data were collected, with blood sampling points before and after the filter as well as peripheral blood. Results:Among the 5 patients, there were 2 males and 3 females, with an average age of 83.2±9.6 years old. A total of 22 treatments were administered, with an average treatment time of 8.8±1.6 hours. All patients had primary diseases of severe pneumonia and COPD; among them, 4 had combined renal injury, and 3 patients were on mechanical ventilation. During the total of 22 treatments, there was 1 instance of dialyzing tube occlusion which led to the end of treatment 2 hours early, while the other 21 treatments were completed smoothly, with no occlusion occurring in the filter, ECCO2R membrane lung, or dialyzing tube. No adverse events such as bleeding occurred in the patients, and there were no statistically significant differences in APTT and PT after treatment compared to before. During the treatment, statistically significant improvements in PaCO2 and blood pH were observed. Conclusion: Extracorporeal carbon dioxide removal combined with continuous renal replacement therapy can partially replace lung ventilation function and improve hypercapnia. NM can be used as an anticoagulant in this technology, with an ideal anticoagulation effect and no significant risk of bleeding.
Keywords: Extracorporeal carbon dioxide removal, anticoagulation, Nafamostat mesylate, Hypercapnia, CRRT
Received: 12 Mar 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 MA, CHEN, Yang, Pan and CHEN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhenhua Yang, Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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