Abstract | BACKGROUND/METHODS: RESULTS: Mean MARS intradialytic systemic pressures were as follows: systolic pressure range was 95 +/- 17 to 128 +/- 17 mmHg and diastolic pressure range was 51 +/- 5 to 67 +/- 7 mmHg. Pressure at albumin dialysate exit point from dialyser 1 (Ae) ranged from 253 +/- 11 to 339 +/- 15 mmHg and that at albumin dialysate entry point into dialyser 1 (Aa) ranged from 142 +/- 11 to 210 +/- 6 mmHg. Ultrafiltration (UF) was 633 +/- 622 mL over mean treatment duration of 6.3 +/- 0.9 h with a total heparin dose of 1583 +/- 817 IU. Coagulation status pre- and 6-h post-MARS was similar: aPTT (P=0.116) and platelet count (P=0.753). There were no bleeding complications or circuit thromboses. MARS had a significant de-uraemization effect (pre- and post-MARS serum creatinine and urea: P=0.046 and 0.028, respectively) but did not significantly attenuate blood lactate, ammonia or total bilirubin levels. Albumin dialysate (Ae - Aa) urea and creatinine concentrations appeared to be sharply attenuated after 6 h of MARS. In contrast, the removal of total bilirubin by albumin dialysate from the blood compartment appeared to plateau after 4 h of continuous MARS operation. CONCLUSIONS: MARS was well-tolerated in critically ill patients with advanced and complicated cancer. Low-dose heparin was safe and did not compromise MARS circuit integrity. Although MARS had a significant de-uraemization effect, this appeared to be limited by the duration of MARS operation. Our data suggested that such a limit was reached earlier for total bilirubin. More data are needed to confirm the present findings and further delineate the saturation limit of MARS for different toxins that accumulate in ALF. This would affect the optimal duration of MARS therapy.
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Authors | H K Tan, J S S Lim, C K Tan, H S Ng, P Chow, H F Lui, G C Wong, P H C Tan, J Raghuram, H N Ng, L H L Choong, K S Wong, K T Woo |
Journal | Liver international : official journal of the International Association for the Study of the Liver
(Liver Int)
Vol. 23 Suppl 3
Pg. 52-60
( 2003)
ISSN: 1478-3223 [Print] United States |
PMID | 12950962
(Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adolescent
- Adult
- Carcinoma, Hepatocellular
(complications, therapy)
- Critical Illness
- Fatal Outcome
- Female
- Hemolytic-Uremic Syndrome
(etiology, therapy)
- Hodgkin Disease
(complications)
- Humans
- Liver Failure, Acute
(etiology, therapy)
- Liver Neoplasms
(complications, therapy)
- Male
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
(complications)
- Renal Dialysis
- Sorption Detoxification
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