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Extracorporeal albumin dialysis
Takaya Abe1, Mineo Shono, Toshihiro Kodama
1Division of Nephrology and Dialysis Center, Kobe University School of Medicine, Hyogo, Japan. takayabe@med.kobe-u.ac.jp
Summary
Extracorporeal albumin dialysis (ECAD) effectively removes albumin-binding toxins (ABT) using albumin dialysate. Systems like MARS and CAPS show promise for artificial kidney and liver support in patients with toxin accumulation.
Area of Science:
- Nephrology
- Hepatology
- Biomedical Engineering
Background:
- Albumin dialysate (AD) is effective in removing albumin-binding toxins (ABT).
- Molecular Adsorption Recycling System (MARS) and Continuous Albumin Purification System (CAPS) are developed blood purification therapies.
- Extracorporeal albumin dialysis (ECAD) encompasses therapies using AD to remove water-soluble and ABT.
Purpose of the Study:
- To define and review extracorporeal albumin dialysis (ECAD) therapies.
- To evaluate the efficacy of ECAD in removing toxins like bilirubin.
- To assess the clinical performance and potential of ECAD systems (MARS, CAPS).
Main Methods:
- Review of studies on dialysis with albumin dialysate (AD).
- Analysis of membrane characteristics (pore size, albumin concentration) for toxin removal.
- Evaluation of clinical data from CAPS and MARS systems.
Main Results:
- Larger pore size membranes and higher albumin concentrations in AD enhance bilirubin removal.
- ECAD systems (CAPS, MARS) can remove various toxins, including ABT.
- CAPS demonstrated continuous 24-hour control of renal and liver function without adverse effects; MARS showed broad benefits and improved survival.
Conclusions:
- ECAD is a potential therapeutic tool for managing diseases with ABT accumulation, acting as an artificial kidney and liver.
- Further research is needed, including the use of recombinant human albumin and acetate-free dialysate.
- ECAD therapies like MARS and CAPS offer significant benefits for critically ill patients.