Extracorporeal Albumin Dialysis in Liver Failure with MARS and SPAD: A Randomized Crossover Trial
| Autor: | Céline Guichon, Cécile Guth, Grégoire Wallon, Frédéric Aubrun, Sylvie Thevenon, J. P. Viale, Serge Duperret, M. Schoeffler, Mathieu Gazon |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Bilirubin medicine.drug_class medicine.medical_treatment Gastroenterology Bile Acids and Salts chemistry.chemical_compound Hepatorenal syndrome Renal Dialysis Internal medicine Albumins medicine Humans Hepatic encephalopathy Dialysis Creatinine Cross-Over Studies Bile acid business.industry Albumin Hematology General Medicine medicine.disease Crossover study chemistry Nephrology Sorption Detoxification business Liver Failure |
| Zdroj: | Blood purification. 51(3) |
| ISSN: | 1421-9735 |
| Popis: | Introduction: Liver failure is associated with hepatic and extrahepatic organ failure leading to a high short-term mortality rate. Extracorporeal albumin dialysis (ECAD) aims to reduce albumin-bound toxins accumulated during liver failure. ECAD detoxifies blood using albumin dialysis through an artificial semipermeable membrane with recirculation (molecular adsorbent recirculating system, MARS) or without (single-pass albumin dialysis, SPAD). Methods: We performed a randomized crossover open trial in a surgical intensive care unit. The primary outcome of the study was total bilirubin reduction during MARS and during SPAD therapies. The secondary outcomes were conjugated bilirubin and bile acid level reduction during MARS and SPAD sessions and tolerance of dialysis system devices. Inclusion criteria were adult patients presenting liver failure with factor V activity Results: Twenty crossovers have been performed. Baseline biochemical characteristics (bilirubin, ammonia, bile acids, creatinine, and urea) were not statistically different between MARS and SPAD. Both ECAD have led to a significant reduction in total bilirubin (−83 ± 67 μmol/L after MARS; −122 ± 118 μmol/L after SPAD session), conjugated bilirubin (−82 ± 61 μmol/L after MARS; −105 ± 96 μmol/L after SPAD session), and bile acid levels (−64 ± 75 μmol/L after MARS; −56 ± 56 μmol/L after SPAD session), all nondifferent comparing MARS to SPAD. Conclusion: A simple-to-perform SPAD therapy with equal to MARS dialysate flow parameters provides the same efficacy in bilirubin and bile acid removal. However, clinically relevant endpoints have to be evaluated in randomized trials to compare MARS and SPAD therapies and to define the place of SPAD in the liver failure care program. |
| Databáze: | OpenAIRE |
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