TITLE

ATTENUATION OF RENAL AND HEPATIC DYSFUNCTION IN A PORCINE ACUTE LIVER FAILURE MODEL USING ALBUMIN DIALYSIS (MARS) WITHOUT HAEMOFILTRATION/HAEMODIALYSIS: PRELIMINARY RESULTS OF A RANDOMISED EVALUATION

AUTHOR(S)
Sen, S.; Ytrebo, L.M.; Rose, C.; Davies, N.A.; Nedredal, G.I.; Revhaug, A.; Williams, R.; Jalan, R.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA103
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Renal dysfunction develops in liver failure, usually due to renal hypoperfusion caused by vasoactive Factor imbalance. The present study attempts to look at hepatic and renal functions in a porcine model of acute liver failure (ALF) treated with albumin dialysis in the form of molecular adsorbents recirculating system (MARS). Methods: 9 female pigs with ALF induced by hepatic devascularisation were followed for 6 hours, with (n = 5) or without (n = 4) MARS treatment (without any haemofiltration/haemodialysis), which began 2 hours after hepatic artery ligation. Hepatic and renal functions were monitored. Results: At start of MARS treatment, serum bilirubin was similar in both groups, but was significantly lower at 6 hours in the ALF-MARS group (194.9 ± 26.0 µmol/L) compared with the ALF group (252.2 ± 29.2 µmol/L) (p = 0.02). Even though haemofiltration/haemodialysis was not used in conjunction with MARS, increase of serum creatinine over the 4 hour treatment period was significantly less in the ALF-MARS group (-23.3 ± 8.8 %) compared with the ALF group (9.6 ± 16.1%) (p = 0.02), while a similar trend was observed with serum urea (5.9 ± 12.5 vs 20.2 ± 14.2%, respectively, p = 0.08). No significant difference of mean arterial pressure or urine output was observed between the 2 groups over this period. Conclusion: MARS was performed in the present study as a pure albumin dialysis because no "renal circuit" was used. The attenuation of renal dysfunction suggests that the removal of albumin bound toxins (for which bilirubin is a surrogate marker) alters the underlying pathophysiology, probably by altering vasoactive factor balance. Further studies will look at potential mechanisms.
ACCESSION #
9747992

 

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