Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial.
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.
Mitzner
S R
SR
Department of Medicine, University of Rostock, Germany. steffen.mitzner@med.uni-rostock.de
Stange
J
J
Klammt
S
S
Risler
T
T
Erley
C M
CM
Bader
B D
BD
Berger
E D
ED
Lauchart
W
W
Peszynski
P
P
Freytag
J
J
Hickstein
H
H
Loock
J
J
Löhr
J M
JM
Liebe
S
S
Emmrich
J
J
Korten
G
G
Schmidt
R
R
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
D000418:Albumins; D015314:Dialysis Solutions