A trial to develop an on-line CHDF machine for the treatment of acute liver failure

Abstract

As a first step to improving the spontaneous survival rate of acute liver failure (ALF), we developed an on-line continuous hemodiafiltration (CHDF) system to recover ALF patients from hepatic encephalopathy. It is necessary to maintain the biological safety of the dialysate when performing on-line CHDF therapy at the bedside in the ICU. For this purpose, two endotoxin retentive filter apparatuses and an automatic cleaning program in the off-period were incorporated into the dialysis machine, which was then fixed exclusively to one reverse osmosis machine. In addition, the control system for monitoring the dialysate flow rate and replacement volume was improved to more precisely fit 24 hours of operation in a relatively low flow rate mode compared with conventional hemodialysis. These mechanical improvements resulted in the capacity to make 288L per day of dialysate and divert 0～170L per day from the dialysate for fluid replacement. A clinical examination is planned to validate the utility of this machine in recovering ALF patients from hepatic encephalopathy.