title: Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial.
abstract: In hepatorenal syndrome (HRS), renal insufficiency is often progressive, and the prognosis is extremely poor under standard medical therapy. The molecular adsorbent recirculating system (MARS) is a modified dialysis method using an albumin-containing dialysate that is recirculated and perfused online through charcoal and anion-exchanger columns. MARS enables the selective removal of albumin-bound substances. A prospective controlled trial was performed to determine the effect of MARS treatment on 30-day survival in patients with type I HRS at high risk (bilirubin level, > or =15 mg/dL) compared with standard treatment. Thirteen patients with cirrhosis with type I HRS were included from 1997 to 1999. All were Child's class C, with Child-Turcotte-Pugh scores of 12.4 +/- 1. 0, United Network for Organ Sharing status 2A, and total bilirubin values of 25.7 +/- 14.0 mg/dL. Eight patients were treated with the MARS method in addition to hemodiafiltration (HDF) and standard medical therapy, and 5 patients were in the control group (HDF and standard medical treatment alone). None of these patients underwent liver transplantation or received a transjugular intrahepatic portosystemic shunt or vasopressin analogues during the observation period. In the MARS group, 5.2 +/- 3.6 treatments (range, 1 to 10 treatments) were performed for 6 to 8 hours daily per patient. A significant decrease in bilirubin and creatinine levels (P <.01) and increase in serum sodium level and prothrombin activity (P <.01) were observed in the MARS group. Mortality rates were 100% in the control group at day 7 and 62.5% in the MARS group at day 7 and 75% at day 30, respectively (P <.01). We conclude that the removal of albumin-bound substances with the MARS method can contribute to the treatment of type I HRS.
authors.affiliation: Department of Medicine, University of Rostock, Germany. steffen.mitzner@med.uni-rostock.de
authors.forename: S R
authors.initials: SR
authors.lastname: Mitzner
authors.forename: J
authors.initials: J
authors.lastname: Stange
authors.forename: S
authors.initials: S
authors.lastname: Klammt
authors.forename: T
authors.initials: T
authors.lastname: Risler
authors.forename: C M
authors.initials: CM
authors.lastname: Erley
authors.forename: B D
authors.initials: BD
authors.lastname: Bader
authors.forename: E D
authors.initials: ED
authors.lastname: Berger
authors.forename: W
authors.initials: W
authors.lastname: Lauchart
authors.forename: P
authors.initials: P
authors.lastname: Peszynski
authors.forename: J
authors.initials: J
authors.lastname: Freytag
authors.forename: H
authors.initials: H
authors.lastname: Hickstein
authors.forename: J
authors.initials: J
authors.lastname: Loock
authors.forename: J M
authors.initials: JM
authors.lastname: Löhr
authors.forename: S
authors.initials: S
authors.lastname: Liebe
authors.forename: J
authors.initials: J
authors.lastname: Emmrich
authors.forename: G
authors.initials: G
authors.lastname: Korten
authors.forename: R
authors.initials: R
authors.lastname: Schmidt
mesh_terms: D000418:Albumins; D015314:Dialysis Solutions; D006530:Hepatorenal Syndrome / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D015314:Dialysis Solutions