For someone who draws a lot of RemSaku fluff I didn't expect this. Mark as 18+ on sites, it really doesn't show anything that would categorize it as such. Again support the artist by buying her works.
The R-18 is because of the kubishime (strangling) play - the artist had to add a funny disclaimer about dangers involved for people who arent vampires (aka don't try this at home and do it responsibly if you're into this).
You are right though; fetish play still falls under Non-H (or Misc for western) if there is no nudity. That's some really cute softcore femdom yuri right here (Sakuya's and Remlia's faces just say it all, switch on), always a great thing, will definitely buy this one!