Albumin dialysis: single pass vs. recirculation (MARS)

Abstract

The single pass albumin dialysis (SPAD) was reported to be an alternative to the Molecular Adsorbent Recirculating System (MARS) for the effective removal of protein bound substances in liver failure. Three SPAD experiments using different albumin concentrations and dialysate flow rates were performed. In each experiment, 1000 ml human donor plasma, spiked with 250 mg unconjugated bilirubin, 200 mg sulfobromophthalein (BSP) and 115 mg glycocholic acid (N-[3alpha,7alpha,12alpha-trihydroxy-24-oxycholan-24-yl]glycine) - a conjugated bile acid (BA), circulated in a closed loop with 150 ml/min and was dialysed against albumin solution. These substances are bound to the different binding sites of albumin and have different association constants. For the comparison, the standard MARS experiment was performed using the same plasma flow rate of 150 ml/min. Moreover, the clearances of bilirubin for MARS and SPAD during clinical treatments were calculated using own data and those reported by Seige, Kreymann, Jeschke, et al. in Transplant Proc 1999; 31: 1371-5. The concentrations of bilirubin, BSP and BA were measured in plasma and dialysate and for these substances clearances (Cl) were calculated. It is known that the elimination rate of bilirubin is not very high during albumin dialysis in comparison to other substances, like bile acids, due to the high association constant. An increase of albumin concentration or the flow rate improved the efficacy but also raised the costs substantially. In this study, we have shown that MARS is the more effective kind of albumin dialysis for the important substances like bile acids. By SPAD an improvement of efficacy can be reached only by dramatic increase of the costs. Also, the earlier experiments showed that MARS is safer because of the removal of the stabilizers, which are normally included in the commercial albumin solutions.

In vitro comparison of the molecular adsorbent recirculation system (MARS) and single-pass albumin dialysis (SPAD)

“…12 However, they applied SPAD without hemodiafiltration. In addition, only 1000 mL of plasma were used in their experiments.…”

“…11 Little is known about the detoxification capacity of these two methods of albumin dialysis under comparable conditions. 12,13 The aim of this study was to compare the detoxification capacities of SPAD and MARS in vitro under standardized conditions. As a control, CVVHDF was also evaluated.…”

Pediatric Renal Replacement Therapy in the Intensive Care Unit

“…In the patient with hemodynamic instability, CRRT is the modality of choice to clear exogenous intoxications. In addition, single-pass albumin dialysis and molecular adsorbent recirculation system can be performed to remove toxins which are highly proteinbound and do not have a very large volume of distribution such as carbamazepine, methotrexate, phenytoin, and acetaminophen [51][52][53][54][55][56]. As opposed to AKI, patients receiving dialysis for the treatment of an acute intoxication typically require a dialysis fluid or replacement fluid with therapeutic concentrations of phosphorus and potassium to avoid electrolyte abnormalities [48].…”

Multiorgan Dysfunction: the State-of-the-Art and Current Approaches to Its Treatment Using Low Flow-Rate Membrane Technologies

“…С одной стороны мембраны ди ализата перфузировалась кровь больного, с другой -донорский альбумин. Это позволило достичь эффективной элиминации би лирубина, однако суммарный объем необходимого альбумина исчисляется десятками литров [76,77]. Дальнейшим развитием идеи альбуминового диализа стало создание технологии МАРС (молекулярной адсорбирующей рециркулирующей системы), использующей регенерацию связывающей способности донор ского альбумина [78].…”