Treatment of chronic uremia has focused on reducing the generation of nitrogenous end products of protein breakdown, or on their removal by dialysis techniques. Treatment of many thousands of patients with chronic uremia has demonstrated that diet and dialysis can sustain life, although they do not correct all the metabolic consequences of renal failure and many features of uremia continue unabated. Attention has been directed over the last two decades to the properties of sorbents in an attempt to increase the efficiency of the dialysis technique. Oral sorbents such as oxystarch and charcoal, have been of considerable interest, but as yet remain of unproven value as the sole treatment for severe uremia. However, sorbent regeneration of dialysate (see Chapter 19), is now accepted in the clinical management of uremia. This chapter will deal with direct contact of blood with sorbents within cartridges (columns), primarily reviewing the potential use of hemoperfusion in uremia, but also discussing the application of hemoperfusion in drug intoxication, hepatic encephalopathy, and other potential uses (Figure 1).


Hepatic Encephalopathy Activate Charcoal Continuous Ambulatory Peritoneal Dialysis Fulminant Hepatic Failure Artif Organ 
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© Kluwer Academic Publishers 1989

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  • James F. Winchester

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