Extracorporeal Albumin Dialysis Helpful for Pruritus From Primary
Biliary Cirrhosis

Extracorporeal Albumin Dialysis Helpful for Pruritus From Primary
Biliary Cirrhosis


Laurie Barclay, MD


June 25, 2004 - Extracorporeal albumin dialysis (ECAD) may be an
effective therapy for intractable pruritus from primary biliary
cirrhosis, according to the results of a case series published in
the June issue of the American Journal of Gastroenterology.

"Pruritus is a distressing symptom in patients with primary biliary
cirrhosis, and when uncontrollable it is an indication for liver
transplantation," write Albert Parés, MD, from the Institut
d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) in
Barcelona, Spain, and colleagues. "Since pruritus can result from
unknown substances that accumulate systemically as a consequence of
impaired biliary secretion, we have assessed whether a new ECAD
procedure, the molecular-adsorbing recirculating system - MARS, has
any effect on pruritus of cholestasis."

Four patients with intractable pruritus from primary biliary
cirrhosis received 2 seven-hour ECAD sessions one day apart. Using a
visual analog scale (VAS), pruritus was recorded 15 days before the
first session, before and after each session, and during follow-up.
The investigators also measured standard liver function tests and
serum bile acid levels.

After ECAD treatment, itching rapidly disappeared in two patients.
Except for short periods with mild pruritus, one of these patients
had no pruritus for 18 months. In the second patient, itching
disappeared almost completely and recurred mildly four months later.

The remaining two patients had dramatically decreased pruritus after
ECAD, but it gradually recurred. Repeat ECAD treatments nine and
seven months later were associated with further improvements in
pruritus.

As itching resolved, so did the pruritic skin lesions. Circulating
bile acids decreased in all patients after ECAD, but there were no
other changes in liver tests, and no significant adverse effects.

Study limitations include small sample size and lack of control
patients.

"The ECAD procedure seems to be an effective alternative for the
treatment of patients with pruritus of cholestasis who do not
respond to other therapeutic methods," the authors write. "Further
studies are required to establish the frequency and the duration of
this treatment. The procedure also opens new perspectives for
understanding the pathogenesis of pruritus of cholestasis, since it
may be possible to elute the potential pruritogen substance from the
albumin dialysate."

The Instituto de Salud Carlos III helped support this study.

Am J Gastroenterol. 2004;99:1105-1110

Reviewed by Gary D. Vogin, MD