Abstract: Objective To prospectively evaluate the effect of hemodialysis with fresh frozen plasma-based dialysate (HD-PBD) plus high volume hemofiltration (HVHF) for the clearance of serum bilirubin in patients with heperbilirubinemia. Methods Fifteen patients with liver failure were included in this study. After HD-PBD therapy for the first 6 hours, patients were then treated with HVHF for 24 hours using the same AV600 filter. Blood and the plasma-based dialysate from vein and artery end of the filter were taken at 0, 2, 4 and 6h during HD-PBD. Blood before and after filtration as well as the ultrafiltrate were also taken at 0, 6, 12 and 24h during HVHF. Bilirubin was determined in dialysate, ultrafiltrate and plasma. Results ①?The clearance rate of serum bilirubin with HD-PBD for 6 hours was significantly higher than that with HVHF for 24 hours (P<0.05). ② The Kd for serum total bilirubin (TB) was (23.0±3.4) ml/min at the beginning of HD-PBD. After HD-PBD for 4-6 hours, the Kd for TB decreased significantly. ③ At the beginning of HD-PBD, the total clearance amount of TB by dispersion and adsorption were (15.6±5.6) mmol/min and (10.3±3.2) mmol/min, respectively, and then decreased significantly after using the filter for 4～6 hours. ④ In HVHF, TB was mainly removed by adsorption. After HVHF for 12h, clearance by adsorption decreased significantly, but the amount of clearance by ultrafiltration remained stable. ⑤ The clearance amount of TB by HD-PBD at the beginning decreased significantly but higher than those by HVHF for 24 hours (P<0.05). Conclusion HD-PBD plus HVHF, a newly proposed modality for patients with liver failure, can decrease serum bilirubin efficiently. Dispersion and adsorption are the major mechanisms of serum bilirubin clearance in HD-PBD, of which the ability decreased gradually after 4 hours of dialysis. Convection and adsorption are the major mechanisms of serum bilirubin clearance in HVHF, but the efficiency is relatively low.

Key words: Liver failure, Hemofiltration, Dialysis, Liver, Artificial