Dialysis against a Recycled Albumin Solution Enables the Removal of Albumin‐Bound Toxins

Stange, Jan; Ramlow, Wolfgang; Mitzner, Steffen; Schmidt, R.; Klinkmann, H

doi:10.1111/j.1525-1594.1993.tb00635.x

Cited by 198 publications

(90 citation statements)

References 4 publications

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“…The "regenerated" albumin is then recirculated, allowing for removal of more toxins from the blood. 22,23 A roller pump (Stöckert Shiley, Munich, Germany) and the MARS pump perfusing the blood and albumin dialysate were running at the same rate (15 0 mL/minute).…”

Section: Methodsmentioning

confidence: 99%

Association of reduced extracellular brain ammonia, lactate, and intracranial pressure in pigs with acute liver failure

et al. 2007

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We previously demonstrated in pigs with acute liver failure (ALF) that albumin dialysis using the molecular adsorbents recirculating system (MARS) attenuated a rise in intracranial pressure (ICP). This was independent of changes in arterial ammonia, cerebral blood flow and inflammation, allowing alternative hypotheses to be tested. The aims of the present study were to determine whether changes in cerebral extracellular ammonia, lactate, glutamine, glutamate, and energy metabolites were associated with the beneficial effects of MARS on ICP. Three randomized groups [sham, ALF (induced by portacaval anastomosis and hepatic artery ligation), and ALF؉MARS] were studied over a 6-hour period with a 4-hour MARS treatment given beginning 2 hours after devascularization. Using cerebral microdialysis, the ALF-induced increase in extracellular brain ammonia, lactate, and glutamate was significantly attenuated in the ALF؉MARS group as well as the increases in extracellular lactate/pyruvate and lactate/glucose ratios. The percent change in extracellular brain ammonia correlated with the percent change in ICP (r 2 ‫؍‬ 0.511). Increases in brain lactate dehydrogenase activity and mitochondrial complex activity for complex IV were found in ALF compared with those in the sham, which was unaffected by MARS treatment. Brain oxygen consumption did not differ among the study groups. A cute liver failure (ALF) is defined by the occurrence of hepatic encephalopathy (HE), which is characterized by an increase in intracranial pressure (ICP) that may lead to cerebral herniation, an important cause of death. 1 Current hypotheses suggest that increased ICP in ALF is the result of multiple factors that involve the effects of hyperammonemia, increased cerebral blood flow, and inflammation. 2 Increased brain ammonia, arising from the onset of hyperammonemia, is detrimental to neurological function. 3 Arterial ammonia levels, ammonia brain delivery, and metabolic rate correlate with severity of intracranial hypertension and risk of cerebral herniation. 1,4,5 Alterations in brain energy metabolism have been hypothesized to be involved in the cerebral consequences of ALF because ammonia is known to inhibit the rate-limiting enzyme ␣-ketoglutarate dehydrogenase in the tricarboxylic acid cycle (TCA). 6 This is supported by experiments demonstrating an increase in de novo synthesis of lactate 7,8 from glucose (using nuclear magnetic resonance spectroscopy) in the brains of rats with ALF. As a result, this would lead to less adenosine triphosphate (ATP) production per molecule of glucose compared with that in aerobic metabolic pathways (through TCA cycle). Therefore, increased ammonia in the brain reduces generation of ATP. On the other hand, elevated ammonia

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Section: Methodsmentioning

confidence: 99%

Association of reduced extracellular brain ammonia, lactate, and intracranial pressure in pigs with acute liver failure

et al. 2007

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“…The characteristics of the 70 patients in the 2 treatment groups, the primary liver disease, and the precipitating factors of HE are presented in Table 2; 56% and 44% exhibited grade 3 or 4 HE, respectively. The median CTP score was 13 (range, 10-15), the model for end-stage liver disease (MELD) score was 32 (range, 11-50) and the GCS was 6 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15]. At baseline, the groups were statistically comparable.…”

Section: Participantsmentioning

confidence: 96%

“…6 Extracorporeal albumin dialysis (ECAD) using the molecular adsorbent recirculating system (MARS) is a new method of hemodiafiltration whereby blood is dialyzed against an albumin-containing solution across a high-flux membrane. 7 The technique allows combined removal of albumin-bound and water-soluble toxins. [8][9][10][11][12] In uncontrolled trials of ECAD using the MARS device, patients had a reduction in ammonia levels, clear-ance of aromatic amino acids, and improvement in systemic hemodynamics.…”

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confidence: 99%

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

et al. 2007

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Extracorporeal albumin dialysis (ECAD) may improve severe hepatic encephalopathy (HE) in patients with advanced cirrhosis via the removal of protein or non-protein-bound toxins. A prospective, randomized, controlled, multicenter trial of the efficacy, safety, and tolerability of ECAD using molecular adsorbent recirculating system (MARS) was conducted in such patients. Patients were randomized to ECAD and standard medical therapy (SMT) or SMT alone. ECAD was provided daily for 6 hours for 5 days or until the patient had a 2-grade improvement in HE. HE grades (West Haven criteria) were evaluated every 12 hours using a scoring algorithm. The primary endpoint was the difference in improvement proportion of HE between the 2 groups. A total of 70 subjects [median age, 53; 56% male; 56% HE grade 3; 44% HE grade 4; median model for end-stage liver disease (MELD) 32 (11-50) and CPT 13 (10-15)] were enrolled in 8 tertiary centers. Patients were randomized to ECAD ؉ SMT (n ‫؍‬ 39) or SMT alone (n ‫؍‬ 31). Groups were matched in demographics and clinical variables. The improvement proportion of HE was higher in ECAD (mean, 34%; median, 30%) versus the SMT group (mean, 18.9%; median, 0%) (P ‫؍‬ 0.044) and was reached faster and more frequently than in the SMT group (P ‫؍‬ 0.045). H epatic encephalopathy (HE) is a complex neuropsychiatric syndrome commonly seen in patients with advanced liver disease. HE arises from the effects of circulating toxins on cerebral functions. Putative toxic molecules accumulate in patients with liver decompensation because of increased production, portal-systemic shunting, or lack of hepatic detoxification. 1 Patients with advanced cirrhosis and a superimposed acute liver injury often decompensate and present with manifestations of hepatic failure, including worsening HE and coma. 2 .Current therapy for HE includes the use of nonabsorbable disaccharides or poorly absorbable antibiotics, as proposed more than 3 decades ago. 3 However, standard therapy is less effective in patients with severe degrees of liver failure. 4,5 Under these circumstances, the concept of supporting the failing liver for a time while correcting the precipitating event might help patients recover from HE or be stabilized until they receive a liver transplant. 6 Extracorporeal albumin dialysis (ECAD) using the molecular adsorbent recirculating system (MARS) is a new method of hemodiafiltration whereby blood is dialyzed against an albumin-containing solution across a high-flux membrane. 7 The technique allows combined removal of albumin-bound and water-soluble toxins. [8][9][10][11][12] In uncontrolled trials of ECAD using the MARS device, patients had a reduction in ammonia levels, clear-

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“…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].…”

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

Danilov¹,

М²

2011

rmt

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Данный аналитический обзор литературы обобщает имеющиеся на настоящее время данные по лечению полиорганной недостаточности (ПОН). В обзоре описывается патогенез, пусковые механизмы и компоненты ПОН, а также совре менные подходы к лечению данной патологии с помощью современных мембранных технологий. Ключевые слова: МАРС терапия, низкопоточная пролонгированная вено венозная гемодиафильтрация, полиорганная недостаточность. This analytical literature review generalizes the currently available data on the treatment of multiorgan dysfunction (MOD).The review describes the pathogenesis, triggers, and components of MOD, as well as current approaches to treating this pathology with up to date technologies.

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Dialysis against a Recycled Albumin Solution Enables the Removal of Albumin‐Bound Toxins

Cited by 198 publications

References 4 publications

Association of reduced extracellular brain ammonia, lactate, and intracranial pressure in pigs with acute liver failure

Association of reduced extracellular brain ammonia, lactate, and intracranial pressure in pigs with acute liver failure

Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis

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

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