Utility of nafamostat mesilate (FUT) in non-heparinized hemodialysis (NHHD)

In this study we performed NHHD using FUT with a dialyzer composed of ethylene vinylalcohol copolymer (EVA) hollow fiber and measured activated coagulation time (ACT) by Hemochron 800 as an index of coagulation time and the concentration of FUT in blood. Subjects were nine patients treated by regular hemodialysis who had a high risk of bleeding. Six patients were males and three were females. The average age was 49.7±5.0 years old. We performed NHHD a total of 267 times by priming with 1, 000ml of saline including 20mg of FUT and by injecting 10mg of FUT per hour. ACT was measured with a Hemochron 800 manufactured by International Technidyne Co. Ltd. Results: 1. ACT before NHHD was 169.2±2.4 sec, after 1 hour 165.9±2.4, after 2 hours 164.8±3.0, after 3 hours 156.1±2.3, after 4 hours 143.9±4.2 and after 5 hours 165.0±3.1. 2. ACT after 5 minutes was 173.9±3.8, after 10 minutes 169.2±4.0, after 20 minutes 158.3±6.7 and after 30 minutes 160.7±5.0. ACT showed no significant changes during NHHD using FUT. 3. The average concentration of FUT in blood at an injection rate of 10mg per an hour was 67.6±7.7ng/ml. The concentration of FUT after 1 hour was 58.0±14.6, after 2 hours 73.3±14.6 and after 3 hours 70.4±13.9. The concentration of FUT showed no significant changes during NHHD. The concentration of FUT in the arterial chamber prehemodialyzer was 2, 067±224ng/ml and that in the venous chamber 1, 100±150. These results demonstrated that the removal rate of FUT was 47.4±3.8% by hemodialysis and 92.5±1.3% within the body. 4. The average dose of FUT used in NHHD was 10.7±0.3mg/hr by EVA, 17.8±1.6 by PMMA and 16.8±0.5 by cuprophane. The EVA dialyzer used a significantly lower dose of FUT in NHHD as compared with both PMMA and cuprophane dialyzer. From the above results, it was suggested that NHHD using FUT and an EVA dialyzer was usephul for patients with a high risk of bleeding and that FUT was useful as a localized anticoagulant in non-heparinized hemodialysis.