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Hepatic hemodialysis units designed for the partial external support of liver function by removing large amounts of water-soluble and albumin-bound substances at a slow and steady rate (i.e., continuous replacement therapy machines). Blood is removed via an extracorporeal circuit, using either arteriovenous access (typically femoral artery to femoral vein) or venous-venous access (e.g., jugular, femoral, subclavian vein), passed through a dialyzer and membrane (e.g., polysulphone) that filters out water-soluble toxic substances (e.g., ammonia, bilirubin, creatinine, urea, fatty acids) and albumin-bound toxins, and returned to the patient. Continuous replacement therapy hepatic hemodialysis units also perform other procedures, such as filtration and replacement of fluids (usually calcium and lactate) by convection (hemofiltration) and/or a combination of hemodialysis and fluid replacement procedure by diffusion and convection (hemodiafiltration). The main components of the unit usually include a dialysate delivery system that delivers the previously prepared dialysate solution from a bag to the dialyzer, an extracorporeal blood-delivery circuit that slowly circulates a portion of the patient\'s blood through the dialyzer and returns to the patient, a disposable dialyzer with specialized membrane filters in which the solute exchange takes place, and devices that perform fluid replacement. Each component has its own monitoring and control circuits. These units are intended for the treatment of chronic and/or acute liver disease and dysfunction after liver transplantation; the devices usually provide temporary liver function support while the patient waits for recovery or as a bridge to transplantation.
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