Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus

作者：Schaefer Betti; Schaefer Franz; Wittmer Dieter; Engelmann Guido; Wenning Daniel; Schmitt Claus Peter^*

来源：Pediatric Nephrology, 2012, 27(5): 829-834.

DOI：10.1007/s00467-011-2058-8

• Molecular Adsorbents Recirculating System
• Cholestatic pruritus
• Pediatrics
• Numeric rating scale
• Bile acids

Cholestatic pruritus may severely compromise quality of life. The Molecular Adsorbents Recirculating System (MARS) allows removal of pruritogenic substances without exposure to foreign proteins. Pediatric data, however, are scant.
We retrospectively analyzed the efficacy of MARS in three boys with severe cholestatic pruritus. They received a total of 135 MARS sessions during 8, 4, and 13 months prior to liver transplantation. Total serum bilirubin and bile acids were monitored, and pruritus was assessed by a numerical rating scale (NRS 0 = no pruritus, 10 = maximal pruritus).
MARS sessions were initially performed three times weekly at a mean duration of 6.3 +/- 1.4 h. Sessions could be reduced to once weekly and once every other week in two patients. Pre-MARS plasma bile acid concentrations averaged 207 +/- 67 mu mol/l. They declined to 67 +/- 9%, 48 +/- 3%, 38 +/- 14%, and 37 +/- 5% of baseline within 2, 4, 6 and 8 h of therapy, respectively (all p < 0.05). The average interdialytic increase of plasma bile acids was 34 +/- 33 mu mol/l per day. Mean NRS score decreased from 6.5 +/- 2.3 to 3.3 +/- 2.9 (p < 0.01). Skin lesions from itching disappeared. All MARS treatments were well tolerated.
MARS dialysis substantially reduces cholestatic pruritus in children refractory to pharmacological treatment.

• 出版日期2012-5