1. Single-Pass Albumin Dialysis During Continuous Renal Replacement Therapy for Management of Liver Failure
Nathan Beins1, MD ; Brooke English2, RN ; Marita Thomas2, MD ; Uttam Garg3, Ph.D. ; Darcy Weidemann1, MD ; Vimal Chadha1, MD
Section of Nephrology1, Critical Care Medicine2, Pathology and Laboratory Medicine3, Children’s Mercy, Kansas City, MO, United States

2. Background
Acute Kidney Injury (AKI) is a relatively common occurrence in critically ill children and many require renal replacement therapy
Most critically ill children with AKI requiring CRRT will also have multi-organ dysfunction
Multiorgan dysfunction syndrome (MODS) occurs in ~20% of critically ill children with an associated ~10% mortality1

3. Background II
Liver dysfunction is commonly seen in MODS while fulminant hepatic failure is rare2
Rarely, severe hyperbilirubinemia (SHB) occurs and is associated with increased mortality
SHB also interferes with laboratory analyses (creatinine, alkaline phosphatase, etc.) and near-infrared spectroscopic (NIRS) monitoring

4. Methods
Our aim was to evaluate the effectiveness of single-pass albumin dialysis in conjunction with CRRT for bilirubin clearance
Single pass albumin dialysis (SPAD) was performed for severe hyperbilirubinemia in four sequential patients already receiving CVVHDF therapy for severe AKI/fluid overload
Serum and effluent total bilirubin levels were monitored during SPAD therapy

5. Single-Pass Albumin Dialysis
Single pass albumin dialysis (SPAD) was performed in conjunction with the standard CVVHDF system at our institution
SPAD was performed via the addition of 400 mL of 25% albumin to the dialysis fluid (5L) thereby achieving a 1.85% albumin solution

6. First Experience

7. Serum Bilirubin during SPAD
SPAD discontinued
Colored lines represent four individual patients

8. % decrease in bilirubin during SPAD
Results
Patient
Age (yrs)
Sex
Diagnosis
Max. bilirubin (mg/dL)
Length of
SPAD (hrs)
% decrease in bilirubin during SPAD
Outcome 1
0.6 M
Hemophagocytic histiolymphocytosis
51.5 35
56%
Expired 2 7
Cystic fibrosis, sepsis, acute on chronic liver failure
32.6 96
42%
Recovered,
expired 3 weeks. later 3 5
Fulminant acute liver failure with encephalopathy
23.9 26
21%
Received liver transplant 4
Neuroblastoma, post-HCT with VOD 32
240
73%
Recovered, expired 1.5 years later

9. Conclusions Caveats & Future Questions
Single pass albumin dialysis can effectively clear severe hyperbilirubinemia
Caveats & Future Questions
- Small sample size
- No hard outcomes
- Uncertain removal of nutrients & medications
- Expense and limits of albumin supply
- Effectiveness in comparison to other modalities (e.g. plasmapharesis, MARS)

10. Questions

11. References
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