Prometheus® 4008H — dialysis and adsorption in one machine
The Prometheus® 4008H therapy system fulfils two important therapeutic functions, dialysis and adsorption, in one machine.
The Prometheus® device is based on Fresenius Medical Care’s well-established dialysis system 4008H. Prometheus® combines an adsorptive process and high-flux hemodialysis.
In the first step, the patient's albumin (and the toxins bound to it) are separated from the blood by means of the special AlbuFlow® AF01 albumin filter. To remove the toxins, the albumin is passed over two adsorbers, prometh® 01 and prometh® 02. The adsorbers have a great affinity for the toxins and are therefore able to detach them from the albumin and bind them.
The purified albumin is then returned to the albumin filter and passed back to the blood. In the next step, water-soluble toxins are removed by hemodialysis.
The prometh® 01 adsorber contains a highly-porous, neutrally-charged resin in its large inner surface area (similar to activated carbon).
This large surface adsorbs albumin-bound organic compounds such as aromatic amino acids, phenols and bile acids.
The adsorber material in prometh® 02 is an anion exchange resin in chloride form that is also highly porous.
It adsorbs albumin-bound anions (e.g., bilirubin) from solutions in exchange for equivalent amounts of chloride ions.
The AlbuFlow albumin filter is a hollow fibre membrane filter made of Fresenius Polysulfone®.
The filter membrane’s large pores allow albumin-rich plasma to pass through it and enter the secondary plasma circuit, where toxins are detached from the albumin. Cells and larger solutes remain in the primary blood circuit.
Benefits of the Prometheus® system
- Effective removal of toxins by hemodialysis and adsorption1
- No exogenous albumin is required
- Improved survival probability of patients with very severe acute-on-chronic liver failure2
A clinical setup requires the Prometheus® 4008H device
1 Krisper, Peter et al. Journal of Hepathology 2005; 43: 451–57.
2 Kribben, Andreas et al. Gastroenterology 2012; 142 (4): 782–89.