2011
DOI: 10.1111/j.1525-139x.2011.00827.x
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Renal Replacement Therapy in Special Settings: Extracorporeal Support Devices in Liver Failure

Abstract: Hepatorenal syndrome (HRS) type I is a unique form of acute kidney injury resulting from renal vasoconstriction in the setting of systemic and splanchnic arterial vasodilation in patients with end-stage liver disease. The only definitive treatment currently available is liver or liver-kidney transplantation. The goal of extracorporeal support (ECS) systems in HRS is to bridge eligible liver failure patients to transplantation or functional recovery by means of detoxification, assistance with biosynthesis of ke… Show more

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Cited by 9 publications
(8 citation statements)
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References 69 publications
(65 reference statements)
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“…These have been recently reviewed by Cerda et al [28]. These systems consist of membranes and adsorbent-based systems to provide detoxification and dialytic support as well as cell-based systems to provide the excretory, synthetic, and metabolic functions of the liver.…”
Section: Introductionmentioning
confidence: 99%
“…These have been recently reviewed by Cerda et al [28]. These systems consist of membranes and adsorbent-based systems to provide detoxification and dialytic support as well as cell-based systems to provide the excretory, synthetic, and metabolic functions of the liver.…”
Section: Introductionmentioning
confidence: 99%
“…This paradoxical response of the kidney is often explained with the difficult to test concept of "arterial underfilling." Employing this concept, it follows that fluid removal in such a patient may worsen arterial underfilling and thus lead to worsening kidney function (3).…”
Section: Both Systems Have Been Tested Over the Last 20 Years In Varimentioning
confidence: 99%
“…They also remove agents involved in the severe pruritus associated with a failing liver (particularly severe cholestatic disease) and have been utilized in its therapy. Intracranial pressure can be decreased by use of either method making them useful in treatment of the most acutely fatal consequences of hepatic encephalopathy .…”
mentioning
confidence: 99%
“…Third, RRT has the potential to maintain the plasma ionized calcium concentration while raising pH, thus potentially improving myocardial contractility (43). There are few studies of RRT relevant to the treatment of lactic acidosis, and most are in the setting of sepsis with hemodynamic instability (44). Almost all involve continuous RRT (CRRT).…”
Section: What Is the Most Effective Treatment For The Patient?mentioning
confidence: 99%
“…Thus, metformin removal by dialysis has figured prominently in the management of patients with MALA (50). Metformin is readily dialyzable, owing to its low molecular weight and lack of protein binding (44). Because of its very high volume of distribution and two-compartment elimination kinetics (50), metformin's removal may be best accomplished with prolonged extracorporeal therapy, either intermittent (49) or continuous (51).…”
Section: What Is the Most Effective Treatment For The Patient?mentioning
confidence: 99%