Hemodynamic Effects of Albumin Dialysis in Patients With Liver Failure: For Better or For Worse?

Abstract

Liver failure, irrespective of is cause, is frequently associated with multi-organ dysfunction, including hemodynamic instability, and renal and cerebral insufficiency. As a result of the combined impact of these complications, liver failure carries an exceptionally high risk of mortality. A central role in the etiopathogenesis of different end-organ manifestations, as well as in the aggravation of the underlying liver failure, has been attributed to the hyperdynamic (hypotensive) state, which is characterized by a reduced systemic vascular resistance and mean arterial pressure, as well as an increased cardiac index, heart rate, and total plasma volume. Since the accumulation of toxins due to the decreased detoxification capacity by the failing liver is considered vital herein, the emergence of extracorporeal liver support has provided a rational basis for the potential reversal of these phenomena. The present article critically reviews data with regard to the hemodynamic effects of artificial liver support in the context of liver failure. Although these are scarce for acute liver failure, several uncontrolled series and small randomized trials have clearly documented that artificial liver support is able to improve both portal hypertension and the associated systemic circulatory dysfunction in patients with acute-on-chronic liver failure. The molecular basis for these effects have been related to temporary changes and/or elimination in endogenous vasoactive substances, improved albumin binding capacity, or restoration of oxidative stress-mediated damage to albumin.

Efficient Removal of Serum Bilirubin by a Novel Artificial Liver Support System Using Albumin Convection: A Pilot Study

“…Albumin dialysis including MARS can remove protein-bound toxins by employing albumin fluid as the dialysate to facilitate protein-bound toxins in the blood to dissociate and diffuse across an albumin nonpermeable membrane, with or without an online refreshment of albumin dialysate [12,13,14]. However, there are some problems including the consumption of large amounts of commercial human albumin, which may lead to unwanted compounds in commercial albumin solution entering the body [15,16] and limited depurative capacity for protein-bound toxins.…”

In Vitro Investigation of the Interaction of Tolbutamide and Losartan with Human Serum Albumin in Hyperglycemia States

“…It is generally believed that disorders within the spatial structure of the most important transporter proteins—the human serum albumins—induce pathological processes. The albumins with modified structures have been identified in the blood of patients with cirrhosis and chronic liver failure [ 7 ], diabetes mellitus [ 8 , 9 ] and also some cancers [ 10 ]. Despite the stabilization through the seventeen intra-subdomain disulfide bridges, albumin undergoes glycation that might affect the loss of physiological function.…”

Management of decompensated liver cirrhosis in the intensive care unit

“…Gambro), erreicht werden [33]. Es gab über viele Jahre zunächst nur kleinere Studien, in denen sich insgesamt gute Entgiftungsergebnisse, d. h. Abfall von Bilirubin und Verringerung der Enzephalopathie einhergehend mit günsti-gen Auswirkungen auf die Hämodyna-mik, gezeigt haben [21,44]. In 2 größeren prospektiven randomisierten multizentrischen Studien wurde nun aktuell untersucht, inwieweit für Patienten mit sog.…”