In vivo quantification of liver dialysis: comparison of albumin dialysis and fractionated plasma separation.
OBJECTIVE
Artificial liver support represents a potentially useful option for the treatment of severe liver failure. A sufficient 'dose' might be crucial for such treatments to provide a survival benefit. The aim of this study was to compare in vivo efficiency and resulting delivered treatment dose of two commercially available devices that use different therapeutic principles: albumin dialysis (AD, MARS) and fractionated plasma separation (FPS, Prometheus).


METHODS
Eight patients with acute-on-chronic liver failure were treated alternately with AD and FPS. Thirty-two treatments at identical blood and dialysate flow rates were evaluated. Clearance and reduction ratio (a measure of delivered treatment dose) were compared for bilirubin subfractions, ammonia and urea.


RESULTS
FPS achieved significantly higher clearance for all measured protein-bound and water-soluble markers. This resulted in significantly higher reduction ratios for FPS compared to AD. Unconjugated bilirubin, a marker for strongly albumin-bound toxins, was influenced only by FPS.


CONCLUSIONS
FPS provided a higher delivered treatment dose than a matching treatment with AD. Reduction ratios of bilirubin and urea should be reported in clinical studies on liver dialysis, since delivered dose is likely to be linked to the clinical effectiveness of extracorporeal liver support therapies.
Krisper
Peter
P
Division of Nephrology and Hemodialysis, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 27, A-8036 Graz, Austria. peter.krisper@meduni-graz.at
Haditsch
Bernd
B
Stauber
Rudolf
R
Jung
Aleksandra
A
Stadlbauer
Vanessa
V
Trauner
Michael
M
Holzer
Herwig
H
Schneditz
Daniel
D
D000368:Aged; D003956:Dialysis / Q000379:methods*; D006801:Humans; D008099:Liver; D017093:Liver Failure / Q000628:therapy*; D019164:Liver, Artificial; D008875:Middle Aged; D010956:Plasmapheresis; D012709:Serum Albumin / Q000493:pharmacokinetics*
D012709:Serum Albumin