Extracorporeal albumin dialysis.
Previous studies reported that dialysis with albumin dialysate (AD) was effective in removing albumin-binding toxins (ABT), and the Molecular Adsorption Recycling System (MARS) and Continuous Albumin Purification System (CAPS) have been developed. These blood purification therapies were categorized into the concept of extracorporeal albumin dialysis (ECAD). ECAD is defined as extracorporeal therapies using AD for the removal of not only water-soluble but also ABT. It was reported that symmetric as well as asymmetric membrane dialyzers had the effect of the removal of bilirubin by AD. The larger pore size membrane can remove more bilirubin. In the greater albumin concentration in AD, the removal capacity for bilirubin by AD increased. Bilirubin in AD could be removed by a charcoal and a bilirubin adsorption column, and its concentration in AD remained approximately constant. In clinical performance of CAPS, cellulose triacetate membrane, 5% AD, bilirubin adsorber columns, and charcoal adsorber columns were used. This system was applied continuously for 24 h for treatment. CAPS could control not only renal but also liver function during the 24 h, without any adverse effect. MARS removes many toxic substances including ABT, and has beneficial effect on brain, liver, renal, and cardiovascular functions, and improvement of 30-day survival were reported. ECAD may become a possible therapeutic tool in patients with the disease state of ABT accumulation as an artificial kidney and liver. However, several attempts such as the application of recombinant human albumin and acetate free dialysate, should be required.
Abe
Takaya
T
Division of Nephrology and Dialysis Center, Kobe University School of Medicine, Hyogo, Japan. takayabe@med.kobe-u.ac.jp
Shono
Mineo
M
Kodama
Toshihiro
T
Kita
Yuji
Y
Fukagawa
Masafumi
M
Akizawa
Tadao
T
D000418:Albumins / Q000378:metabolism*; D001663:Bilirubin / Q000378:metabolism*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D011485:Protein Binding; D006435:Renal Dialysis / Q000379:methods*
D000418:Albumins; D001663:Bilirubin