Plasma exchange (PE) is often performed in combination with
hemodialysis (HD) or
hemodiafiltration. However, most methods were developed for the treatment of
renal failure, so various problems may arise during treatment of
liver failure (LF). In this study, we investigated the impact of PE alone and in combination with HD, and we assessed the complications of using PE + HD for the treatment of LF. After the exchange of 1 L of fresh frozen plasma (FFP), we measured serum
electrolytes, HCO(3) (-),
citrate, and
acetate at 3 points in the circuit: A) the plasma separator inflow; B) after mixing of FFP/the dialyzer inflow; and C) the dialyzer outflow. Serum levels of human
hepatocyte growth factor (HGF),
acetate, and
citrate were also measured before and after PE + HD. The levels of K(+), Ca(++), HCO(3) (-), and
acetate were significantly decreased, and
citrate was increased, between A and B. K(+) and
citrate were decreased, while Ca(++), HCO(3) (-), and
acetate showed an increase between B and C. Comparison of A with C revealed insufficient correction of the Ca(++) and
citrate levels by HD. After PE + HD, serum levels of
acetate and
citrate were increased, while HGF was decreased. We concluded that i) when PE is performed, HD is also necessary for correction, but achieves insufficient correction of Ca(++) and
citrate, ii) PE is non-selective and not only removes toxins but also beneficial substances such as HGF, iii) accumulation of
acetate occurred, even with
bicarbonate dialysate, since it also contains
acetate for acidification.