Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure

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Abstract
The aim of this pilot study is to evaluate the circulatory safety of treatment with the molecular adsorbents recirculating system (MARS) by determining the effect on systemic hemodynamics of a single MARS treatment in patients with acute-on-chronic liver failure (AOCLF). In eight patients admitted with AOCLF, a single 10-hour MARS treatment was performed. Systemic hemodynamic variables were determined before and during treatment. Bilirubin and urea were monitored as measures of protein-bound and water-soluble toxins. During MARS treatment, mean arterial pressure increased from 67 ± 9 to 76 ± 6 mm Hg (P < .05). Systemic vascular resistance index increased from 757 ± 134 to 884 ± 183 dyne · s/cm5/m2 (P < .05), whereas cardiac index remained constant (5.9 ± 0.7 v 6.0 ± 1.1 L/min/m2). No episode of dialysis-induced hypotension was observed. Systemic oxygen consumption remained constant (92 ± 30 v 93 ± 11 mL/min/m2). Bilirubin levels decreased from 537 ± 192 to 351 ± 106 μmol/L (P < .05), and urea levels, from 19.1 ± 13.9 to 6.7 ± 5.1 mmol/L (P < .05). In conclusion, MARS treatment proved safe in critically ill patients with no attributing side effects.