Single Pass Albumin Dialysis in Reducing Bilirubin Levels in Adult Patients with Liver Failure

Patients with hyperbilirubinemia usually have multiple complications that impact the quality of life and survival. By exploring Single Pass Albumin Dialysis (SPAD) as a potential treatment for lowering bilirubin and not just for bridging to Liver Transplant, the study can contribute on the development of effective strategies in the management of liver failure patients. Effective management for hyperbilirubinemia in patients with liver failure is needed as traditional therapies have limitations and SPAD may offer a more novel approach in improving bilirubin clearance. Understanding SPAD’s efficacy can provide a better therapeutic option for managing hyperbilirubinemia in this patient population.

This study employed a single-center retrospective cohort which included a population of 12 patients from January 1, 2023 to December 31, 2024 who were diagnosed with liver failure (Child-Pugh class B or C) and had elevated bilirubin levels (≥ 2 mg/dL). All these patients underwent SPAD and pre and post SPAD bilirubin were taken from all these patients The dialyzer used for all these patients was AV1000S (1.8m2) whereas, the modality was Continuous Veno-venous Hemodiafiltration (CVVHDF) for 8 of the patients and Continuous Veno-venous Hemodialysis (CVVHD) for 2 of the patients. 3% Albumin concentration was used in the dialysate of all of the patients. Blood flow rate of 150ml/min and albumin-dialysate flow of 1000ml/hr was used for all of the patients.

The minimum total bilirubin level decreased from 8.3 mg/dL to 5.8 mg/dL, while the maximum reduced from 38 mg/dL to 27.5 mg/dL. The reduction in the Median Bilirubin Levels were pre- SPAD of 21.75mg/dL and post- SPAD 15.72 mg/dL. The post-SPAD total bilirubin, median bilirubin decreased by 6.03 mg/dL (21.75 to 15.72) while the maximum bilirubin levels dropped significantly from 38 to 27.5 mg/dL. There was also a reduction in median conjugated bilirubin levels following the SPAD procedure. It shows that pre-SPAD median conjugated bilirubin was 15.65, with a median absolute deviation (MAD) of 5.4, this indicates substantial variability among the participants, ranging from 4.1 to 24.05. Post-SPAD, the median conjugated bilirubin was decreased to 11.53, bhut variability slightly increased (MAD = 6.05). The results of the Wilcoxon Signed Rank Test indicate a statistically significant decrease in total bilirubin levels post-SPAD (median from 21.75 to 15.72 mg/dL; p-value = 0.003). It showed a statistically significant reduction in conjugated bilirubin levels post-SPAD (median decreased from 15.65 to 11.53 mg/dL; p-value = 0.002), and a statistically substantial decrease in unconjugated bilirubin levels post-SPAD (median reduction from 6.15 to 5.3 mg/dL; p-value = 0.015). For the platelets, no statistically significant difference in counts post-SPAD (median from 50,250 to 52,500 cells/µL; p-value = 0.583).

SPAD is an effective intervention for reducing bilirubin levels in patients with liver failure. Decreasing the levels of bilirubin in these patients may lead to better clinical outcomes especially when used to decrease the complications of hyperbilirubinemia such as encephalopathy, jaundice, cholestasis, hemolysis and other important clinical manifestations. However, since the study has a small population, a need for an individualized treatment plan and further monitoring would be of value to prove a more specific insight in this type of treatment for liver failure.