Albumin dialysis: a new therapeutic strategy for intoxication from protein-bound drugs

Intensive Care Med. 2004 Mar;30(3):496-501. doi: 10.1007/s00134-003-2141-0. Epub 2004 Jan 21.


Objective: Although water-soluble drugs can be removed by haemofiltration/haemodialysis, morbidity and mortality from intoxication with protein-bound drugs remains high. The present study investigates whether albumin dialysis in the form of the Molecular Adsorbents Recirculating System (MARS) is effective in removal of protein-bound drugs.

Design: Prospective animal study.

Setting: Surgical research laboratory in a university hospital.

Subjects: Seven female Norwegian Landrace pigs.

Intervention: We studied whether midazolam (97% albumin-bound) and fentanyl (85% alpha-1-acid glycoprotein-bound), administered as anaesthetics to pigs with induced acute liver failure, could be removed by MARS dialysis lasting for 4 h.

Measurements: After 4 h of dialysis, total and free anaesthetic concentrations were measured in the blood and dialysate from different segments of the MARS circuit.

Main results: Midazolam: total plasma concentrations fell by 47.1+/-2.1% (in 4 h) across the MARS filter ( p<0.01). The charcoal component of the system reduced the total dialysate drug concentration by 16.4+/-2.2% ( p<0.05). Free midazolam removal followed a similar pattern. Fentanyl: total plasma concentrations fell by 56.1+/-2.4% (in 4 h) across the MARS filter ( p<0.01). Clearance of fentanyl from the dialysate by the charcoal was 70+/-0.7% at 4 h ( p<0.001).

Conclusions: The results of the study show that MARS can remove both albumin and other protein-bound drugs efficiently from the plasma, and it may have a place for the treatment of patients suffering from intoxication with this class of compounds.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anesthetics, Intravenous / blood*
  • Anesthetics, Intravenous / chemistry
  • Animals
  • Female
  • Fentanyl / blood*
  • Fentanyl / chemistry
  • Linear Models
  • Liver Failure, Acute / therapy*
  • Midazolam / blood*
  • Midazolam / chemistry
  • Orosomucoid
  • Protein Binding
  • Serum Albumin
  • Sorption Detoxification / methods*
  • Swine


  • Anesthetics, Intravenous
  • Orosomucoid
  • Serum Albumin
  • Midazolam
  • Fentanyl