title: Usefulness of plasma exchange plus continuous hemodiafiltration to reduce adverse effects associated with plasma exchange in patients with acute liver failure.
abstract: OBJECTIVE
  To efficiently remove middle-molecular-weight substances such as hepatic toxins and minimize adverse effects associated with plasma exchange implementation, we have performed plasma exchange slowly in combination with continuous hemodiafiltration. This study was designed to determine the usefulness of plasma exchange with continuous hemodiafiltration in reducing the adverse effects associated with implementation of plasma exchange alone.
  
  
  METHODS
  A retrospective clinical study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  The study involved 90 patients with liver failure who had been treated with plasma exchange in our department over the past 12 yrs. We examined these patients by dividing them into two groups (48 patients treated with plasma exchange alone and 42 patients treated with plasma exchange plus continuous hemodiafiltration at the time of plasma exchange implementation).
  
  
  RESULTS
  Baseline blood Na+ concentration, HCO3- concentration, and colloid osmotic pressure were followed after implementation of plasma exchange to compare the frequency of development of three adverse effects (hypernatremia, metabolic alkalosis, and sharp decrease in colloid osmotic pressure) in the two groups. Hypernatremia was found in 26.7% of treatments in the group with plasma exchange alone and 3.3% in the group of plasma exchange plus continuous hemodiafiltration, and metabolic alkalosis was found in 30.6% of treatments in the group with plasma exchange alone and 4.9% in the group of plasma exchange plus continuous hemodiafiltration; both percentages were significantly higher in the group with plasma exchange alone (p <.001). A sharp decrease in colloid osmotic pressure occurred in 13.3% of treatments in the group with plasma exchange alone but was not observed at all in the patients treated with plasma exchange plus continuous hemodiafiltration.
  
  
  CONCLUSIONS
  We conclude that adverse effects associated with plasma exchange for artificial liver support for liver failure can be alleviated with use of plasma exchange plus continuous hemodiafiltration instead of plasma exchange alone.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University School of Medicine, Chiba, Japan. sadahiro@air.linkclub.or.jp
authors.forename: T
authors.initials: T
authors.lastname: Sadahiro
authors.forename: H
authors.initials: H
authors.lastname: Hirasawa
authors.forename: S
authors.initials: S
authors.lastname: Oda
authors.forename: H
authors.initials: H
authors.lastname: Shiga
authors.forename: K
authors.initials: K
authors.lastname: Nakanishi
authors.forename: N
authors.initials: N
authors.lastname: Kitamura
authors.forename: T
authors.initials: T
authors.lastname: Hirano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000471:Alkalosis / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003102:Colloids; D003131:Combined Modality Therapy; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D006955:Hypernatremia / Q000209:etiology / Q000517:prevention & control; D007223:Infant; D017114:Liver Failure, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009997:Osmotic Pressure; D010951:Plasma Exchange / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D003102:Colloids