ABSTRACT
Extraction of protein bound liver failure toxins, such as unconjugated bilirubin, short chain fatty acids, and aromatic amino acids has been reported using hemodiafiltration with albumin in the dialysate, but the characteristics of such a system have not been described. Therefore, bilirubin clearance using albumin dialysate hemodiafiltration was evaluated in the setting of different dialysate albumin concentrations, varying temperature and pH. An in vitro continuous hemodiafiltration circuit was used with single pass countercurrent dialysis. Unconjugated bilirubin was added to bovine blood and filtered across a polyalkyl sulfone (PAS) hemofilter using matched filtration and dialysate flow rates. The serial bilirubin content was measured and first order clearance kinetics verified. The clearance rate constants were calculated for three dialysate groups of different albumin concentration at constant temperature and pH (group 1: 10 g/dl albumin, n = 5; 2 g/dl albumin, n = 5; normal saline, n = 5), and three groups of different temperature and pH at constant albumin dialysate concentration (group 2: pH = 7.0, temperature = 20 degrees C, n = 5; pH = 7.5, temperature = 20 degrees C, n = 5; pH = 7.0, temperature = 40 degrees C, n = 5). Comparisons were made with ANOVA and Tukey post hoc analysis. When albumin was used in the dialysate, the 2 g/dl group cleared bilirubin 3.1 times faster than saline alone (p = 0.001), and the 10 g/dl group was superior to both (p = 0.001). There were no measurable differences between the 2 g/dl groups at the various temperatures tested (p = 0.08), but the clearance was less at a pH of 7.5 (p = 0.015). The clearance of unconjugated bilirubin is greatly enhanced with the use of albumin containing dialysates when compared to traditional crystalloid hemodiafiltration, is greater at lower pH, and seems to be unaffected by temperature.
Subject(s)
Bilirubin/blood , Bilirubin/isolation & purification , Hemodiafiltration/methods , Albumins , Animals , Cattle , Evaluation Studies as Topic , Hemodiafiltration/instrumentation , Hemodialysis Solutions , Hepatic Encephalopathy/blood , Hepatic Encephalopathy/therapy , Humans , Hydrogen-Ion Concentration , In Vitro Techniques , TemperatureABSTRACT
A 42-year-old man was admitted to the Cancer Division of the American MedicalCenter in February, 1956. He had been treated for erythrocytosis beginning 6 months previously, with reduction of his hemoglobin to relatively normal values. On admission, a huge tumor of the left kidney was palable. Roentgenograms of the chest demonstrated small bilateral pulmonary metastases. A left nephrectomy was per formed, followed by wedge resection of a total of 16 metastatic nodules, 12 of which showed metasticrenal carcinoma. It is now 18 years since the last thoracotomy and the patient is well, leading a normal life, and free of any demonstrable malignant disease and any evidenceof erythrocytosis.
