Extracorporeal Albumin Dialysis

Abstract:  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.

[1]  Toshihiro Kodama,et al.  In vitro study of bilirubin elimination by dialysis , 1995 .

[2]  S. Mitzner,et al.  Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. , 2001, Journal of the American Society of Nephrology : JASN.

[3]  Toshihiro Kodama,et al.  Pregnancy and delivery in patients with chronic renal failure , 1997 .

[4]  Roger Williams,et al.  Albumin dialysis MARS 2003: what evidence, how to proceed? , 2003 .

[5]  R. Bartlett,et al.  Can the clearance of tumor necrosis factor alpha and interleukin 6 be enhanced using an albumin dialysate hemodiafiltration system? , 1999, ASAIO journal.

[6]  T. Risler,et al.  Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial , 2000, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[7]  P. J. McKenna,et al.  Fulminant hepatitis with coma successfully treated by plasmapheresis and hyperimmune Australia-Antibody-rich plasma. , 1972, The American journal of gastroenterology.

[8]  C. Bowmer,et al.  Decreased drug binding in uraemia: effect of indoxyl sulphate and other endogenous substances on the binding of drugs and dyes to human albumin. , 1982, Biochemical pharmacology.

[9]  T. Hassanein,et al.  The effect of extracorporeal albumin dialysis on plasma phospholipid fatty acids in patients with end‐stage liver disease , 2003, Liver international : official journal of the International Association for the Study of the Liver.

[10]  Hong-yu Zhang,et al.  Application of Molecular Adsorbents Recirculating System to remove NO and cytokines in severe liver failure patients with multiple organ dysfunction syndrome , 2003, Liver international : official journal of the International Association for the Study of the Liver.

[11]  T. Kawaguchi,et al.  Tumor necrosis factor-alpha and interferon-gamma directly impair epithelial barrier function in cultured mouse cholangiocytes. , 2003, Liver international : official journal of the International Association for the Study of the Liver.

[12]  U Kragh-Hansen,et al.  Structure and ligand binding properties of human serum albumin. , 1990, Danish medical bulletin.

[13]  J. Hoofnagle,et al.  SERUM LEVELS OF GAMMA-AMINOBUTYRIC-ACID-LIKE ACTIVITY IN ACUTE AND CHRONIC HEPATOCELLULAR DISEASE , 1983, The Lancet.

[14]  Julien Bogousslavsky,et al.  Fatigue after Stroke: A Major but Neglected Issue , 2001, Cerebrovascular Diseases.

[15]  Massimo Malago,et al.  Albumin dialysis in cirrhosis with superimposed acute liver injury: A prospective, controlled study , 2002, Hepatology.

[16]  R. Bañares,et al.  Hepatic and systemic haemodynamic changes after MARS in patients with acute on chronic liver failure , 2003, Liver international : official journal of the International Association for the Study of the Liver.

[17]  M. Löhr,et al.  Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support. , 1999, Artificial organs.

[18]  J. Stange,et al.  A new procedure for the removal of protein bound drugs and toxins. , 1993, ASAIO journal.