Background. Acute on chronic liver failure (AoCLF) represents a life-threatening complication of liver cirrhosis with high mortality if patients cannot be bridged to emergency liver transplantation. The aim of this study was to assess clinical and paraclinical effects of renal replacement therapy (RRT) in combination with a hemadsorption column in patients with AoCLF. Methods. Patients were included in the study after Intensive Care Unit (ICU) admission and RRT in combination with CytoSorb® was started for three consecutive sessions. Clinical and paraclinical data were recorded before the first session and after the end of the third session. 28-days mortality was also noted. Results. Fourteen patients were included in the final data analysis. The use of CytoSorb® was associated with a decrease in bilirubin levels (p = 0.03) and creatinine (p = 0.02) and an increase in urine output (p = 0.02). Although we observed a significant decrease in platelet count (p = 0.05), no haemorrhagic complications were noted. C-Reactive Protein significantly decreased after the therapy (p = 0.05), but we did not observe a similar decrease in leucocyte count (p = 0.87) or procalcitonin levels (p = 0.18). Seven patients underwent emergency liver transplantation and survival was 100% in this group. Conclusion. The use of CytoSorb® was associated with an improvement in liver and renal functions and a decrease in C - Reactive Protein. Thrombocytopenia represents the main adverse effect of the therapy, but no haemorrhagic complications were recorded. In patients that could be bridged to liver transplantation, survival was 100%. Trial registration number: NCT04511507