ADVOS Questions and Answers

The ADVOS multi is intended for combination with ADVOS fluids for patients with acute, chronic, or acute-to-chronic liver failure or kidney failure.

The aims of treatment are:

• Removing water-soluble and protein-bound  toxic substances. 
• Normalising and improving blood composition in cases of electrolyte imbalance or acid-base imbalance.
• Removing fluids in cases of overhydration.

There are no known contraindications.

The haemodialysis device is not intended for:

• Children
• Breast-feeding mothers
• Pregnant persons
• Patients with prion diseases, e.g. Creutzfeldt–Jakob disease

The ADVOS multi circulation takes place inside the machine with two specially designed filters.

The first innovative feature is the method, which combines the benefits of human serum albumin dialysis (efficient detoxification of protein-bound substances) with further benefits (low consumption of human serum albumin, high flow of dialysate, low flow of blood).
In addition, the procedure’s scalability is innovative, i.e. the possibility of specifically supporting the lungs, liver, kidneys and acid-base balance with just one machine – something that so far is only possible with the ADVOS multi.

The procedure can be used for as long as the treating physician considers necessary, although the machine must be disinfected every 24 hours. Uninterrupted treatment is therefore possible with two machines.

Treatment typically lasts up to 24 hours, depending on the aim of treatment. In the case of lung support, for example, 24 hours of continuous treatment makes sense, whereas for liver or kidney dialysis, 8 hours of treatment are possible, depending on the indication.

In principle, however, the duration of organ support is up to the treating physician; the only restriction on the method side is that the machine needs to be disinfected every 24 hours. Uninterrupted treatment is possible if two machines are used.

We are currently developing further options for organ support, both in specifically designed devices and as additions within the ADVOS multi.

The number of treatments depends on the clinical picture; typically, patients are treated three to ten times, but some patients have been successfully treated as many as 100 times.

Acid and alkaline concentrates are used to reduce and raise (respectively) the pH value in the two separate ADVOS regeneration circuits, in order to filter out toxins.

The added acid and base are converted into water and common salt in the ADVOS reservoir after the separate purification circuits: HCl + NaOH => H₂O + NaCl and are then disposed of through the dialysis circuit’s filtrate.

The filtrate is disposed of by the ADVOS multi fluid management, by means of the container system, and into the clinic’s/practice’s disposal drain.

The acid and base and the canister must be disposed of as hazardous waste. Note the following:

• Once treatment is complete, seal the canister with the canister lid.
• Contact the local authorities for information on regional regulations concerning disposal.
• Dispose of uncleaned packaging in accordance with official regulations.
• Dispose of acid concentrate separately from the alkaline concentrate (base).
• Prevent these from entering the public sewage system.

Two dialysers are used in the purification circuits within the ADVOS multi circuit (one in the acid circuit and one in the base circuit). Two other dialysers are needed in the blood circulation to ensure effective purification by the human serum albumin dialysate, given the large surface area.

For method-specific reasons and for reasons of regulatory approval, only dialysers from the ADVOS multi treatment set may be used. If dialysers that have not been approved by ADVITOS are used, no liability is assumed and the user in question bears sole responsibility for any complications or side effects in the patient undergoing treatment.

ADVOS multi offers the following benefits compared to competitors:

• Simultaneous support for all three excretory organs: lungs, liver and kidneys
• Possible to focus on a leading organ
• Lung support without the need for large-lumen vascular access and high flow rates
• Progressive treatment of kidney failure by removing water-soluble and also protein-bound nephrotoxins
• Bicarbonate-independent treatment of severe metabolic and respiratory acidosis
• Acidosis therapy by means of adjusting the pH and bicarbonate to the specific patient during treatment
• Low consumption of human serum albumin
• Continuous and intermittent treatment possible

As the method is still very new, there are only a limited number of studies in animal and test subjects available, which we will be happy to send to you. Further studies are currently underway or in preparation. Our field service will be happy to provide details.

Data available to date from the EMOS register attests to good treatment results. For details, our Literature Service would be happy to help or we can refer you to experienced users.

Unlike all other combined dialysis devices, the ADVOS multi does not require a gas exchanger for CO₂ removal, using a chemical process instead: Physiologically, CO₂ +H₂O (carbon dioxide and water) are in constant equilibrium with H⁺ + HCO₃⁻ (proton and bicarbonate), according to what is known as the Henderson-Hasselbalch equation:

CO₂ + H₂O <-> H₂CO₃ <-> H⁺ + HCO₃⁻

If you remove the proton (H⁺) and bicarbonate (HCO₃⁻) from the right side of the equation, the body recreates it from carbon dioxide (CO₂) and water (H₂O), thus reducing the CO₂ on the left side of the equation.

If you increase the pH value in the ADVOS dialysate while simultaneously reducing the bicarbonate content, the concentration gradient causes both protons (H⁺) and bicarbonate (HCO₃⁻) to move from the blood through the dialyser to the dialysate, thereby lowering the CO₂ content in the blood.

See also “What are the indications for ADVOS multi?”

In the ADVOS multi circulation, the human serum albumin dialysate is separated into two independent circuits, to which acid or base concentrate is added, respectively, in order to lower or increase the pH value. In the acid circuit, positively charged substances (such as copper and CO₂) are removed from the dialysate, while in the base circuit, negatively charged substances (such as bilirubin and bile acid) are removed. Next, the retreated dialysate is merged in order to pass through the dialysis filters again.

All anticoagulants that are taken for kidney dialysis can also be used with the ADVOS multi.

• Heparin
• Calcium citrate
• Epoprostenol (Flolan)
• Thrombin inhibitors (Argatroban)

For the recommended dosing, refer to our brief guide or the clinic’s own standards. We do not recommend operating the ADVOS multi without any anticoagulation.