title: Effective bilirubin reduction by single-pass albumin dialysis in liver failure.
abstract: Albumin dialysis is widely accepted as a liver-support technique for patients with liver failure. The Molecular Adsorbent Recirculating System, the widely accepted albumin dialysis technique, has limited use in developing countries because of its technical difficulties and high cost. Therefore, we assessed the efficacy of the more practical modality, the single-pass albumin dialysis (SPAD), in terms of bilirubin reduction, as a marker of albumin-bound toxins removal, as well as the patient outcomes. Twelve acute or acute-on-chronic patients with liver failure who had hyperbilirubinemia (total bilirubin > 20 mg/dL) were treated with SPAD by using 2% human serum albumin dialysate for 6 h. SPAD treatment significantly improved the levels of total bilirubin, conjugated bilirubin, urea, and creatinine (P < 0.001 for all parameters). The reduction ratios of these four parameters were 22.9 +/- 3.8%, 20.9 +/- 5%, 19.0 +/- 4.1%, and 27.7 +/- 3.2%, respectively. No significant difference was observed between serum ammonia before and after treatment. No significant changes in mean arterial pressures were noted during the maneuver, representing cardiovascular tolerability. No treatment-related complications were found. The 15-day in-hospital survival was 16.7%. However, a subgroup of the patients who had moderate severity showed 100% 15-day-survival rate (2 of 2 patients). In conclusion, SPAD is salutarily effective in reducing bilirubin in patients with liver failure. The procedure is safe and simply set up.
authors.affiliation: Department of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Ussanee
authors.initials: U
authors.lastname: Boonsrirat
authors.forename: Khajohn
authors.initials: K
authors.lastname: Tiranathanagul
authors.forename: Nattachai
authors.initials: N
authors.lastname: Srisawat
authors.forename: Paweena
authors.initials: P
authors.lastname: Susantitaphong
authors.forename: Piyawat
authors.initials: P
authors.lastname: Komolmit
authors.forename: Kearkiat
authors.initials: K
authors.lastname: Praditpornsilpa
authors.forename: Kriang
authors.initials: K
authors.lastname: Tungsanga
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-Ong
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood*; D003956:Dialysis; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000627:therapeutic use*; D016060:Sorption Detoxification; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D001663:Bilirubin