OBJECTIVE To evaluate the anticoagulant efficacy and safety of nafamostat mesylate （NM） in the treatment of uremic patients at high risk of bleeding undergoing continuous veno-venous hemofiltration （CVVH） with different methods （pre- dilution and post-dilution）. METHODS A total of 130 uremic patients at high risk of bleeding who underwent CVVH treatment in the nephrology department of Chongqing University Three Gorges Hospital from July 2023 to September 2024 were selected. They were divided into pre-dilution group and post-dilution group according to the random number table method， with 65 cases in each group. Both groups of patients received CVVH treatment under NM anticoagulation. The pre-dilution group adopted the pre-dilution replacement method， while the post-dilution group adopted the post-dilution replacement method. The coagulation， pressure， and usage duration of the filter and dialysis circuit venous reservoirs were compared between the two groups. The changes in prothrombin time （PT）， prothrombin time-international normalized ratio （PT-INR）， activated partial thromboplastin time （APTT）， and fibrinogen （FIB） in the peripheral venous blood before the heparin pump and after the filter at 1， 4 and 7 h of CVVH treatment， as well as 20 min after the end of treatment， were compared between the two groups. The single-compartment urea clearance rate （spKt/V）， β2-microglobulin （β2-MG） clearance rate and the incidence of adverse reactions were duni2007@foxmail.com compared between the two groups. RESULTS Both the pre-dilution and post-dilution groups had 60 patients who completed the study. The incidence of grade Ⅱ-Ⅲ coagulation of the filter and venous reservoirs， as well as the number of patients with transmembrane and venous pressure alarm intervention in the post- dilution group were significantly higher or more than those in the pre-dilution group （P＜0.05）， while usage time of the filter and the pipeline in the post-dilution group was significantly shorter than that in the pre-dilution group （P＜0.05）. The APTT values before the heparin pump as well as PT and APTT values after the filter at 1 h， 4 h， and 7 h of CVVH treatment in the post-dilution group were significantly higher than those in the pre-dilution group （P＜0.001）. There were no significant differences in PT， PT- INR， APTT and FIB between the two groups of patients 20 min after the end of treatment （P＞0.05）. The spKt/v and β2-MG clearance rates in the post-dilution group were significantly higher than those in the pre-dilution group （P＜0.001）. There was no significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS When NM is used as an anticoagulant in the CVVH treatment of uremic patients at high risk of bleeding， compared with the pre-dilution treatment method， the post-dilution treatment method has a higher incidence of filter and dialysis tubing venous reservoir， a shorter usage time of the filter and pipeline， and a greater impact on extracorporeal coagulation， but has a higher solute clearance rate. Clinically， different dilution methods can be selected according to the different treatment needs of patients.

Objective To investigate the efficacy and safety of blood purification therapy in the treatment of diuretic resistance in patients with nephrotic edema.Methods 40 cases of primary nephrotic syndrome with diuretic resistance in our hospital were randomly divided into hemodialysis (HD) group and continuous blood purification (CVVH) group and each group were 20 cases.All the patients were given basic treatment (lipid modulation,anticoagulation and glucocorticoid) and the observation time was 4 weeks.The changes of biochemical indexes (24 h urine protein,plasma albumin,serum urea nitrogen and serum creatinine) were observed before and after treatment in two groups.In addition,the complications of four groups were recorded.Results After blood purification treatment,urinary volume of two groups were significantly increased,the quantity of 24 h urinary protein and serum albumin were significantly improved,levels of serum urea nitrogen and serum creatinine were significantly decreased.The differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).Compared with HD group,the urine volume increased more obviously in CVYH group after 2 weeks' treatment (P ＜ 0.05).The same time,24 h urinary protein was reduced and plasma albumin was improved more significantly (P ＜ 0.05),levcls of serum urea nitrogen and serum creatinine were not differ between the two groups (P ＞ 0.05).There was no difference in urine volume and renal function between the two groups (P ＞ 0.05) after 4 weeks' treatment.24 h urinary protein was significantly decreased and serum albumin was significantly higher than HD group (P ＜ 0.05).There were no serious complications in the two groups.Conclusion Blood purification in the treatment of diuretic resistance in patients with nephrotic edema is safe and effective.Continuous blood purification treatment can effectively alleviate nephrotic edema with diuretic resistance,promote the recovcry of renal function and improve the prognosis of kidney disease.