AN69ST membranes adsorb nafamostat mesylate and affect the management of anticoagulant therapy: a retrospective study

Abstract

BackgroundIn Japan, nafamostat mesylate (NM) is frequently used as an anticoagulant during continuous renal replacement therapy (CRRT). The dialyzer membrane AN69ST has been reported to adsorb NM and affect the management of anticoagulant therapy. However, the adsorbed amount has not yet been quantitatively assessed. Therefore, in this study, we evaluated the pre- and post-hemofilter prolongation of the activated clotting time (ACT) in patients with AN69ST and PS membranes. We also measured the adsorption of NM in three types of CRRT membranes using an experimental model.MethodsIn a study of patients who underwent CRRT using AN69ST or PS membranes in 2015 at the Advanced Emergency and Critical Care Center, Okayama University Hospital, pre- and post-hemofilter ACT measurements were extracted retrospectively, and the difference was calculated. In addition, AN69ST (sepXiris100), PS (HEMOFEEL SHG-1.0), and PMMA membranes (HEMOFEEL CH-1.0N) were used in an in vitro model of a dialysis circuit, and the concentrations of NM were measured in pre- and post-hemofilter membranes and filtrates.ResultsThe ACT difference was significantly lower in the group using AN69ST membranes (p < 0.01). In the in vitro model (n = 4) with adsorption and filtration, the post-hemofilter and filtrate concentrations of NM in AN69ST membranes were significantly lower than those in the PS and PMMA membranes (p < 0.01). The NM adsorption clearance of the AN69ST membrane was significantly higher than that of the PS and PMMA membranes.ConclusionsThe AN69ST membrane had higher NM adsorption than the PS and PMMA membranes. This may have resulted in the lower ACT difference in patients undergoing CRRT using the AN69ST membrane than in patients undergoing CRRT using PS or PMMA membranes.

Comparison of the circulatory effects of continuous renal replacement therapy using AN69ST and polysulfone membranes in septic shock patients: A retrospective observational study

“…However, the superiority of AN69ST membranes over other membranes has not been demonstrated in many previous studies . In addition, AN69ST membranes adsorb nafamostat mesilate, which may shorten the filter survival when used as the anticoagulant . In our study, we used nafamostat mesilate as the CRRT anticoagulant, and did not observe significantly different filter survival between the groups.…”

“…[15][16][17] In addition, AN69ST membranes adsorb nafamostat mesilate, which may shorten the filter survival when used as the anticoagulant. 18 In our study, we used nafamostat mesilate as the CRRT anticoagulant, and did not observe significantly different filter survival between the groups. This result is concordant with that of the previous study.…”

Nafamostat Mesylate Improved Survival Outcomes of Sepsis Patients Who Underwent Blood Purification: A Nationwide Registry Study in Japan

“…Third, this dataset does not provide detailed information regarding blood purification treatments, such as hemofilter material for renal replacement therapy or NM dose. Especially, hemofilters using acrylonitrile and methallyl sulfonate copolymer (AN69-ST) membranes are known to adsorb NM [ 31 , 32 ], therefore the beneficial effect of NM observed in the present study may have been influenced in cases using the AN69-ST hemofilter. However, this limitation is unlikely because the AN69-ST hemofilter was not approved for CRRT use in Japan during the period of the current study.…”

Adsorption kinetics of high mobility group box 1 protein in a polyacrylonitrile hemofiltration membrane

“…The clearance (CLs; mL/min) of HMGB1 from the solution was calculated as follows 11,12 : where CSi is the concentration at the filter inlet, CSo is the concentration at the filter outlet, Qs is the flow rate of the test solution (mL/min), and Qf is the flow rate of the ultrafiltrate (mL/min).…”