Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: Results of a prospective, randomized, controlled clinical trial

In hepatorenal syndrome (HRS), renal insufficiency is often progressive, an d the prognosis is extremely poor under standard medical therapy. The molec ular adsorbent recirculating system (MARS) is a modified dialysis method us ing an albumin-containing dialysate that is recirculated and perfused onlin e through charcoal and anion-exchanger columns. MARS enables the selective removal of albumin-bound substances. A prospective controlled trial was per formed to determine the effect of MARS treatment on 30-day survival in pati ents with type I HRS at high risk (bilirubin level, greater than or equal t o 15 mg/dL) compared with standard treatment. Thirteen patients with cirrho sis with type I HRS were included from 1997 to 1999. All were Child's class C, with Child-Turcotte-Pugh scores of 12.4 +/- 1.0, United Network for Org an Sharing status 2A, and total bilirubin values of 25.7 +/- 14.0 mg/dL, Ei ght patients were treated with the MARS method in addition to hemodiafiltra tion (HDF) and standard medical therapy, and 5 patients were in the control group (HDF and standard medical treatment alone). None of these patients u nderwent liver transplantation or received a transjugular intrahepatic port osystemic shunt or vasopressin analogues during the observation period. In the MARS group, 5.2 +/- 3.6 treatments (range, 1 to 10 treatments) were per formed for 6 to 8 hours daily per patient. A significant decrease in biliru bin and creatinine levels (P < .01) and increase in serum sodium level and prothrombin activity (P < .01) were observed in the MARS group. Mortality r ates were 100% in the control group at day 7 and 62.5% in the MARS group at day 7 and 75% at day 30, respectively (P < .01). We conclude that the remo val of albumin-bound substances with the MARS method can contribute to the treatment of type I HRS.