LOW-COST SINGLE-PASS ALBUMIN DIALYSIS: OUR INITIAL EXPERIENCE

Introduction:

Single-pass albumin dialysis (SPAD) is one of the simpler methods for removing protein-bound toxins in acute liver failure. However, its use is restricted in resource-limited settings due to its relatively high cost. We present our initial experience with a low-cost SPAD method. 

Methods:

All patients presenting with Acute Liver Failure between July and August 2024 were evaluated for inclusion. SPAD was performed on the advice of the treating gastroenterologist and nephrologist. SPAD was performed using a plasmapheresis filter (P2 dry) connected to a hemodialysis machine. The dialysate circuit consisted of fresh frozen plasma, which was given at a rate of 300 ml/hour, with a blood flow of 150 ml/min. Each session was performed for six hours and was done without anti-coagulation. Serum bilirubin was considered a surrogate marker for protein-bound toxins.

Results:

A total of three patients underwent a total of five sessions of SPAD, while one of them received tandem hemodialysis. The mean age of patients was 48 years, with 66.6% being men. All the patients had Hepatic encephalopathy and acute kidney injury (Table 1). There was a significant decrease in serum bilirubin with SPAD (Figure 1) and no significant difference in PT, INR, or Albumin (Figure 2). No hypotension, premature terminations, or other complications were noted during the procedure. The mortality rate was high at 66.6%, which can be explained by selection bias, with the sickest patients being selected for the therapy. The mean cost for each session was about Rs. 13,500 (USD 161), which is very cost-effective compared to conventional SPAD. Apart from being cost-effective, using FFP could also help in correcting coagulopathy.

Conclusions:

Modified SPAD could be a cost-effective alternative for patients with acute liver failure. Further studies with larger samples are required to establish the efficacy and safety of the procedure.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.