[Efficiency of dialysis with albumin in the treatment of patients with advanced hepatic insufficiency: initial experience with the MARS system in Spain].
During liver failure there is an accumulation of toxic substances secondary to the loss of liver function. In order to eliminate these substances various extracorporeal depuration therapies have been employed. Recently, we have used a new treatment, MARS (Molecular Adsorbent Recirculating System), in 3 patients diagnosed with severe liver failure. This system consists of an albumin rich (20%) dialysate circuit, with two areas of depuration. In one area, the albumin dialysate is in contact with blood through a high-flux albumin coated membrane, where albumin bound substances are eliminated. In the other area, the albumin dialysate is in contact with a standard bicarbonate dialysate through a low-flux membrane, which permits the elimination of water soluble substances. The albumin of the circuit is continuously regenerated through charcoal and ion exchanger filters. In order to determine those liver failure patients suitable to receive MARS therapy we established several inclusion criteria. All patients underwent a complete clinical and biochemical evaluation before and after each treatment. All of them showed an improvement of their clinical (attenuation of pruritus and encephalopathy) and biochemical (decrease of bilirubin levels) parameters. During the period of treatment 2 patients developed an increase in plasma creatinine levels together with a decrease of urinary volume. There were no hemodynamic or technical complications during the treatment. These promising results deserve further controlled studies large enough to permit confirmation.
Avilés
J
J
Servicio de Gastroenterología, Hospital Ntra. Sra. de Candelaria, Santa Cruz de Tenerife.
Macía
M
M
Morales
S
S
Pérez
F
F
Moreno
A
A
Navarro
J
J
Navazo
L
L
García
J
J
D000327:Adsorption; D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D002606:Charcoal; D003404:Creatinine / Q000097:blood; D004231:Diuresis; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005260:Female; D005374:Filtration; D015312:Hemodialysis Solutions / Q000627:therapeutic use*; D006530:Hepatorenal Syndrome / Q000097:blood / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D007475:Ion Exchange Resins; D008105:Liver Cirrhosis, Biliary / Q000150:complications; D008108:Liver Diseases, Alcoholic / Q000150:complications; D017093:Liver Failure / Q000097:blood / Q000150:complications*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008567:Membranes, Artificial; D008970:Molecular Weight; D010539:Permeability; D010865:Pilot Projects; D011183:Postoperative Complications / Q000628:therapy; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D012995:Solubility; D016896:Treatment Outcome
D000418:Albumins; D015415:Biomarkers; D015312:Hemodialysis Solutions; D007475:Ion Exchange Resins; D008567:Membranes, Artificial; D002606:Charcoal; D017693:Sodium Bicarbonate; D003404:Creatinine