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single pass albumin dialysis

Hasan Serdar Kıhtır, Hamdi Murat Yıldırım, Osman Yeşilbaş, Burcu Bursal Duramaz, Esra Şevketoğlu
A girl aged six months was hospitalized because of resistant seizures and was discharged with phenobarbital and carbamazepine therapy. She was admitted to a state hospital with symptoms of inability to waken and difficulty in breathing. It was learned that phenobarbital had been used incorrectly and the patient was sent to our pediatric intensive care unit because of severe phenobarbital overdose. The decision was taken for hemodialysis. Single-pass albumin dialysis was planned because phenobarbital can bind to high levels of plasma protein...
December 2016: Türk Pediatri Arşivi
Mariusz Piechota, Anna Piechota
BACKGROUND: The mortality rate in patients with severe liver dysfunction secondary to alcoholic liver disease (ALD) who do not respond to the standard treatment is exceptionally high. OBJECTIVES: The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support techniques to treat this group of patients. PATIENTS AND METHODS: The data from 23 hospital admissions of 21 patients with ALD who were admitted to the department of anesthesiology and intensive therapy (A&IT) at the Dr Wł...
July 2016: Hepatitis Monthly
Barbara Sinner, Gabriele I Kirchner
Liver failure is a disease with a high mortality rate. Often liver transplantation is the sole therapeutic option. On the one hand, liver support systems probably support the liver to allow regeneration, on the other hand they are an option to bridge for transplantation. This article gives an overview on the clinically used liver assist devices (molecular adsorbent recirculating system [MARS], Prometheus system, single-pass albumin dialysis [SPAD], plasmapheresis) and discusses the applications in liver failure...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Winnie Kwai Yu Chan, Wun Fung Hui
BACKGROUND: High-dose methotrexate therapy (HDMTX) is a common form of chemotherapy used in children with high-grade malignancy such as osteosarcoma. Treatment with HDMTX requires careful monitoring of drug levels with folinic acid (leucovorin) rescue therapy. Toxicity from methotrexate is not uncommon and sometimes causes significant morbidity and mortality. CASE-DIAGNOSIS/TREATMENT: We report an 11-year-old child whose 24-h post-HDMTX serum level was 651.8 μmol/L (recommended level <20 μmol/L), which was complicated by septic shock and progressive renal and liver failure...
October 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Rosa Bianca Schmuck, Gesa-Henrike Nawrot, Panagiotis Fikatas, Anja Reutzel-Selke, Johann Pratschke, Igor Maximilian Sauer
Several artificial liver support concepts have been evaluated both in vitro and clinically. Single pass albumin dialysis (SPAD) has shown to be one of the most simple approaches for removing albumin-bound toxins and water-soluble substances. Being faced with acute liver failure (ALF) in everyday practice encouraged our attempt to define the optimal conditions for SPAD more precisely in a standardized experimental setup. Albumin concentration was adjusted to either 1%, 2%, 3%, or 4%, while the flow rate of the dialysate was kept constant at a speed of 700 mL/h...
February 2017: Artificial Organs
Christoph Sponholz, Katja Matthes, Dina Rupp, Wolf Backaus, Sebastian Klammt, Diana Karailieva, Astrid Bauschke, Utz Settmacher, Matthias Kohl, Mark G Clemens, Steffen Mitzner, Michael Bauer, Andreas Kortgen
BACKGROUND: The aim of extracorporeal albumin dialysis (ECAD) is to reduce endogenous toxins accumulating in liver failure. To date, ECAD is conducted mainly with the Molecular Adsorbents Recirculating System (MARS). However, single-pass albumin dialysis (SPAD) has been proposed as an alternative. The aim of this study was to compare the two devices with a prospective, single-centre, non-inferiority crossover study design with particular focus on reduction of bilirubin levels (primary endpoint) and influence on paraclinical and clinical parameters (secondary endpoints) associated with liver failure...
January 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
Evangelos Tsipotis, Asim Shuja, Bertrand L Jaber
Albumin dialysis is the best-studied extracorporeal nonbiologic liver support system as a bridge or destination therapy for patients with liver failure awaiting liver transplantation or recovery of liver function. We performed a systematic review to examine the efficacy and safety of 3 albumin dialysis systems (molecular adsorbent recirculating system [MARS], fractionated plasma separation, adsorption and hemodialysis [Prometheus system], and single-pass albumin dialysis) in randomized trials for supportive treatment of liver failure...
September 2015: Advances in Chronic Kidney Disease
Xia Tao, Stephan Thijssen, Nathan Levin, Peter Kotanko, Garry Handelman
BACKGROUND: Indoxyl sulfate is a protein-bound uremic toxin and its dialytic clearance is comparatively low. We propose a method to increase indoxyl sulfate dialytic clearance. METHODS: Human serum albumin, preloaded with indoxyl sulfate, was circulated on the blood side of an F40S dialyzer with single-pass counter-current dialysate flow. Tryptophan or docosahexaenoic acid (DHA), which are binding competitors to indoxyl sulfate, were infused into the blood-side circuit upstream of the dialyzer, and their abilities to increase the removal of indoxyl sulfate determined...
2015: Blood Purification
Claudio Ronco, Francesco Garzotto, Alessandra Brendolan, Monica Zanella, Massimo Bellettato, Stefania Vedovato, Fabio Chiarenza, Zaccaria Ricci, Stuart L Goldstein
BACKGROUND: Peritoneal dialysis is the renal replacement therapy of choice for acute kidney injury in neonates, but in some cases is not feasible or effective. Continuous renal replacement therapy (CRRT) machines are used off label in infants smaller than 15 kg and are not designed specifically for small infants. We aimed to design and create a CRRT machine specifically for neonates and small infants. METHODS: We prospectively planned a 5-year project to conceive, design, and create a miniaturised Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM), specifically for neonates and small infants...
May 24, 2014: Lancet
Betti Schaefer, Claus Peter Schmitt
The majority of children with acute, acute-on-chronic, and progressive chronic liver failure require liver transplantation. Since organ availability is limited, extracorporeal liver support systems are increasingly applied to bridge the time until transplantation. At present, four different devices are available: the molecular adsorbent recirculating system (MARS), Prometheus dialysis, plasma exchange combined with hemodialysis (PE/HD), and single-pass albumin dialysis (SPAD). Randomized trials in adults have demonstrated efficient toxin removal, improved portal hypertension, hemodynamic stability, and improved hepatic encephalopathy compared with standard medical therapy...
September 2013: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Guillermo Rosa-Diez, Adrián Gadano
Chronic liver diseases affect 10% of the world population. Five million people per year have acute liver failure in occidental countries. Since more than 30 years now, orthotopic liver transplantation has been the treatment of choice for selected patients with these diseases, but the lack of enough organs to satisfy the increasing need oftransplantations as well as the elevated mortality of the operation in patients in critical condition, has led to search for additional therapies. Within the last years several therapies aiming to support liver function have developed in order to serve as a bridge to liver transplantation or as replace therapy allowing regeneration of the injured live...
June 2012: Acta Gastroenterologica Latinoamericana
A Umgelter, K Lange, A Kornberg, P Büchler, H Friess, R M Schmid
Due to the lack of donor organs for orthotopic liver transplantation (OLT) in Germany, a larger proportion of patients advance to multi-organ failure (MOF) before OLT. Twenty-three patients on the waiting list for OLT were admitted to our intensive care unit (ICU) from January 2007 until September 2009. They consisted of 16 men and 7 women of median (25th-75th percentile) age of 60 years (54-65). Acute Physiology and Chronic Health Evaluation (APACHE II) score upon ICU admission was 26 (19-34); Model of End-Stage Liver Disease (MELD) score was 29 (22-41); Sequential Organ Failure Assessment (SOFA) score was 12 (8-16)...
December 2011: Transplantation Proceedings
Marek Wiśniewski, Małgorzata Barwina, Maciej Zajac, Jacek Sein Anand
UNLABELLED: The number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years. Various methods of extracorporeal liver support have been described in this paper, with particular emphasis on modified single pass albumin dialysis (SPAD). CONCLUSIONS: 1. Single pass albumin dialysis (SPAD) is a promising method of extracorporeal liver support. 2. Due to widespread availability of continuous renal replacement therapy equipment it can be performed in most units providing intensive care...
2011: Przegla̧d Lekarski
Sibylle Rademacher, Michael Oppert, Achim Jörres
Severe liver failure is common and carries a high mortality risk in patients with both acute and acute-on-chronic liver failure. The failing liver constitutes a medical emergency, and in many cases liver transplantation is the only definite treatment. Extracorporeal liver support can be employed as a strategy for bridging to transplantation or recovery. This article focuses on options for artificial (nonbiological) extracorporeal treatment: single-pass albumin dialysis, fractionated plasma separation and adsorption (Prometheus(®)) and the molecular adsorbent recirculatory system...
October 2011: Expert Review of Gastroenterology & Hepatology
Peter Krisper, Vanessa Stadlbauer, Rudolf E Stauber
Toxins accumulating in liver failure split into water solved (e.g. ammonia) and albumin bound substances (e.g. bilirubin). Because the latter cannot be removed by conventional haemodialysis, special liver support systems have been developed. The majority of data concerning elimination efficiency exist for the cell-free devices Molecular Adsorbent Recirculating System (MARS) and Prometheus, as they have been commercially available in Europe since many years. Overall, Prometheus provides higher clearances for most liver toxins, especially if they are tightly albumin bound...
September 2011: Liver International: Official Journal of the International Association for the Study of the Liver
Hannelore Ringe, Verena Varnholt, Miriam Zimmering, Werner Luck, Alexander Gratopp, Kai König, Susanne Reich, Igor M Sauer, Gerhard Gaedicke, Uwe Querfeld
OBJECTIVE: To investigate the applicability, efficacy, and safety of single-pass albumin dialysis in children. DESIGN: Retrospective data review of uncontrolled clinical data. SETTING: University-based pediatric intensive care unit collaborating with a local center for liver transplantation. PATIENTS: Nine children, aged 2 to 15 yrs, who were treated with single-pass albumin dialysis for acute liver failure of various origins under a compassionate-use protocol between 2000 and 2006...
May 2011: Pediatric Critical Care Medicine
Sebastian Koball, Heiko Hickstein, Martin Gloger, Michael Hinz, Jörg Henschel, Jan Stange, Steffen Mitzner
Thyrotoxic crisis (thyroid storm) is a life-threatening condition. Standard therapy is based on thiamazole, prednisolone, and nonselective beta-blockers. Extracorporeal plasmapheresis is an additional tool for removing circulating thyroxine in patients who do not respond quickly to conventional standard therapy. As thyroxine can be bound by albumin, the aims of the present therapy report were to investigate the potential of extracorporeal single-pass albumin dialysis (SPAD) to remove thyroid hormones and to compare it with plasmapheresis...
February 2010: Artificial Organs
A Mary Vilay, Bruce A Mueller, Hilary Haines, Jeffery A Alten, David J Askenazi
Methotrexate, administered for treatment of pediatric and adult malignancies, is a direct renal toxin, which can lead to renal dysfunction, decreased methotrexate clearance, elevated methotrexate concentrations, and systemic toxicity. Although plasma methotrexate concentrations have been shown to decline precipitously after a single dose of glucarpidase, this drug is investigational and available only through compassionate use. Therefore, alternative treatments for methotrexate removal may be required. We describe a 13-year-old girl (body surface area 1...
January 2010: Pharmacotherapy
Csaba Rikker
Liver failure carries a high mortality, both the acute type with no pre-existing liver disease (acute liver failure) and the acute decompensation superimposed on a chronic liver disorder (acute on chronic liver failure). Today, liver transplantation still represents the only curative treatment for liver failure due to end-stage liver diseases. Donor organ shortage is still the major limitation and many patients die while awaiting transplantation. Due to the scarcity of donor organs, liver support technologies are being developed to support patients with severe liver failure until either an organ becomes available for transplantation or their livers recover from injury...
December 20, 2009: Orvosi Hetilap
Sebastian Klammt, Sebastian Koball, Heiko Hickstein, Martin Gloger, Joerg Henschel, Steffen Mitzner, Jan Stange, Emil C Reisinger
Extracorporeal liver support procedures based on albumin dialysis require the use of pharmaceutical-grade human serum albumin (HSA). Those preparations contain octanoate, which is added as stabilizer during the production process. For octanoate, a direct involvement in the pathogenesis of liver failure complications as well as an indirect influence by competitive displacement effects at the albumin molecule have been described. During five Single Pass Albumin Dialysis (SPAD) and three Molecular Adsorbent Recirculating System (MARS) treatments the changes of octanoate concentrations in blood and dialysate were investigated...
October 2009: Therapeutic Apheresis and Dialysis
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