ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO665

Single-Pass Albumin Dialysis with Continuous Renal Replacement Therapy in Patients with Liver Failure

Session Information

Category: Dialysis

  • 602 Dialysis for AKI: Hemodialysis, CRRT, SLED, Others

Authors

  • Chadha, Vimal, Children's Mercy Hospital, Kansas City, Missouri, United States
  • Weidemann, Darcy K., Children's Mercy Hospital, Kansas City, Missouri, United States
  • Beins, Nathan T., None, Kansas City, Missouri, United States
  • Garg, Uttam, Children's Mercy Hospitals and Clinics, Knasas City, Missouri, United States
  • Greene, Rebecca M., Children''s Mercy Hospital, Kansas City, Missouri, United States
  • English, Brooke, Children''s Mercy Hospital, Kansas City, Missouri, United States
  • Thompson, Marita, University of Missouri Kansas City, Children''s Mercy Hospital, Kansas City, Missouri, United States
Background

Multiple organ dysfunction syndrome is not uncommon in critically ill children. While many of these children receive CRRT for management of AKI, there is no standard approach available for managing liver failure in which several metabolites that are highly protein bound accumulate, and thus are not cleared with conventional CRRT. Molecular Adsorbent Recycling System (MARS) has been successfully used in these situations, but is unavailable in most centers. Modification of CRRT with Single-Pass Albumin Dialysis (SPAD) has been reported previously.

Methods

We report our experience in four children who were treated with SPAD-CRRT. All patients received CRRT (CVVHDF) with a clearance of 2 L/hr/1.73m2. For SPAD, 400 mL of 25% albumin was added to the 5 L dialysate (PrismaSol®) bag to give final albumin concentration of 1.85%. Serum bilirubin was used as a surrogate marker of efficacy of SPAD. Serum and dialysate bilirubin concentrations were monitored to calculate the mass bilirubin removal.

Results

The findings are briefly summarized in the Table.

Conclusion

Our experience shows >10-fold increase in bilirubin clearance with SPAD-CRRT. While SPAD-CRRT is effective in decreasing serum bilirubin and other toxins, its impact on removal of nutrients and medications is currently unknown, Further studies are needed to see if SPAD-CRRT can improve patient outcomes.

CaseAge (yrs)SexDiagnosisMax. Bilirubin (mg/dL)SPAD duration (hrs)% reduction in bilirubin with SPADOutcome
10.6MHemophagocytic histiolymphocytosis with liver failure.523556%Expired
27MCystic fibrosis, sepsis, acute on chronic liver failure.339642%Recovered, expired 3 weeks later
35MFulminant acute liver failure.242621%Received liver transplant
43MNeuroblastoma, post-HCT, VOD, and liver failure.3224073%Recovered, expired 1.5 yrs later

While severe hyperbilirubinemia was the main reason for using SPAD in patients 1, 2, and 4, it was used as a bridge to liver transplant in patient #3.