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Emerging indications for albumin dialysis
Sambit Sen1, Roger Williams, Rajiv Jalan
1Institute of Hepatology, University College of London, 69-75 Chenies Mews, London WC1E 6HX, United Kingdom.
The American Journal of Gastroenterology
|January 26, 2005
Summary
Molecular Adsorbents Recirculating System (MARS) liver dialysis removes albumin-bound toxins, improving liver failure symptoms like jaundice and brain dysfunction. Clinical studies show MARS may enhance survival and organ function, though mechanisms require further research.
Area of Science:
- Hepatology
- Nephrology
- Critical Care Medicine
Background:
- Accumulation of albumin-bound toxins contributes to end-organ dysfunction in liver failure.
- Albumin dialysis leverages albumin's binding capacity to remove these toxins.
- Existing liver support systems aim to mitigate toxin burden and its consequences.
Purpose of the Study:
- To review the efficacy and emerging applications of albumin dialysis, specifically the Molecular Adsorbents Recirculating System (MARS).
- To summarize clinical findings regarding MARS in liver failure patients.
- To highlight areas of ongoing research and alternative albumin-based detoxification systems.
Main Methods:
- Review of clinical studies on albumin dialysis, focusing on the MARS device.
- Analysis of reported outcomes including hyperbilirubinemia, encephalopathy, survival, hemodynamics, and renal function.
- Mention of alternative systems like Prometheus (fractionated plasma separation and adsorption) and SPAD.
Main Results:
- MARS demonstrated reduction in hyperbilirubinemia and improvement in hepatic encephalopathy.
- Clinical studies suggest potential improvements in survival, systemic hemodynamics, and renal function.
- Emerging indications include pruritus management and treatment of toxicities from albumin-bound substances.
Conclusions:
- Albumin dialysis, exemplified by MARS, offers a promising approach for managing liver failure complications.
- While clinical benefits are observed, the precise pathophysiological mechanisms underlying MARS efficacy require further elucidation.
- Alternative albumin-based toxin removal systems are under development, with limited current clinical data.
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