Intermittent high‐flux albumin dialysis with continuous venovenous hemodialysis for acute‐on‐chronic liver failure and acute kidney injury

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Abstract
Background Acute‐on‐chronic liver failure (ACLF) requiring intensive medical care and associated with acute kidney injury (AKI) has a mortality rate as high as 90% due to lack of effective therapies. In this study we assessed the effects of intermittent high‐flux single‐pass albumin dialysis (SPAD) coupled with continuous venovenous hemodialysis (CVVHD) on 28‐day and 90‐day survival and an array of clinical and laboratory parameters in patients with severe ACLF and renal insufficiency. Methods 16 patients were studied. The diagnosis of ACLF and AKI was made in accordance with current EASL Clinical Practice Guidelines, including recommendations of the International Club of Ascites. All patients received SPAD/CVVHD treatments as blood purification therapy to support liver, kidneys and other organs. Five patients were transplanted and 11 were not listed for transplantation because of active alcoholism. Data at the initiation of SPAD/CVVHD were compared with early morning data after termination of the extracorporeal treatment phase. Results All patients had ACLF and renal insufficiency with 13/16 additionally fulfilling AKI criteria. A total of 37 SPAD/CVVHD treatments were performed [2.3+1.4]. Baseline MELD‐Na score was 37.6+6.6 and fell to 33.4+8.7 after SPAD/CVVHD (P<.001). In parallel, the CLIF‐C ACLF grade and OF score, estimated 28‐ and 90‐day mortality, AKI stage, hepatic encephalopathy grade, and liver function tests were lowered (P =.001‐.032). The 28‐ and 90‐day survival was 56.2% overall, and 53.8% in AKI. Survival in patients not transplanted (n=11) was 45.4%. Conclusions In patients with severe ACLF and AKI, renal replacement therapy coupled with high‐performance albumin dialysis improved estimated 28‐ and 90‐day survival and several key clinical and laboratory parameters. It is postulated that these results may be further improved with earlier intervention and more SPAD treatments per patient. High‐performance albumin dialysis improves survival and key clinical and laboratory parameters in severe acute‐on‐chronic liver failure and acute kidney injury

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