Removal of bile acids from the blood by hemodialysis with a polyacrylonitril membrane: treatment of pruritus of cholestatic disease.

Hemodialysis with a polyacrylonitril membrane is evaluated as a possible method to alleviate pruritus accompanying severe prolonged cholestasis. To that extent results of a series of 30 dialysis sessions of a patient with advanced primary biliary cirrhosis are reported. Efficacy is measured with a pruritus score, kept by the patient herself, as well as with pre- and postdialysis plasma bile acid concentrations and bile acid concentrations in dialysates. Bile acid removal can then be calculated in three different ways: (a) From the decrease of the plasma bile acid concentration by dialysis a figure of 300 mumol bile acid removed is estimated. (b) Measurements of bile acid concentration in the dialysates results in a figure of 666 +/- (SD) 87 mumol bile acid removed. (c) From the mean pre- and postdialysis plasma bile acid concentrations together with an effective clearance rate of 8 ml/min for the bile acid mixture, calculated from ultrafiltration experiments, a removal of 589 +/- 100 mumol bile acid is calculated. These figures compare favorably with figures reported in the literature for the alternative techniques used, plasmapheresis and plasma perfusion over activated charcoal.