Changes in Intracranial Pressure during Haemofiltration in Oliguric Patients with Grade IV Hepatic Encephalopathy

Davenport, Andrew; Will, Eric J.; Davison, A. M.; Swindells, Stephen; Cohen, A.T.; Miloszewski, K.; Losowsky, M.S.

doi:10.1159/000185727

Cited by 66 publications

(37 citation statements)

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“…Furthermore, increased intracranial pressure can rise during liver transplantation [23]. Increased intracranial pressure rises during IHD and is stable or falls with CRRT [15,24]. Therefore, all patients with fulminant hepatic failure should be treated with CRRT.…”

Section: Introductionmentioning

confidence: 99%

The Challenges of Providing Renal Replacement Therapy in Decompensated Liver Cirrhosis

Gonwa¹,

Wadei²

2012

Blood Purif

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Development of renal failure requiring renal replacement therapy (RRT) in the cirrhotic patient is a devastating complication. Survival without RRT is less than 10% on average at 6 months. However, it is now appreciated that all renal failure in this group of patients is not due solely to hepatorenal syndrome, and the cause of the renal failure affects the prognosis. This paper reviews the prognosis depending on cause and points out the difficulty in making the correct diagnosis. Provision of RRT is difficult in this group of patients due to hypotension and coagulopathy which is highly prevalent. Survival with RRT is still poor with only 30–60% of patients surviving to liver transplant. Provision of RRT should be offered as a bridge to patients awaiting liver transplant or those undergoing liver transplant evaluation. Provision of long-term RRT is usually not indicated in other cirrhotic patients who develop a need for RRT except as a trial to see if renal function will return. The decision between intermittent hemodialysis or continuous renal replacement therapy (CRRT) is usually based on the clinical characteristics of the patient. Neither has been demonstrated to be superior to the other, although CRRT may be better tolerated in the unstable patient. CRRT is clearly indicated in cases of fulminant hepatic failure as it does not raise intracranial pressure. Provision of intraoperative CRRT during liver transplant may be indicated to help control volume and electrolytes in those patients presenting for liver transplant with renal failure. Newer extracorporeal support systems, such as extracorporeal albumin dialysis (MARS) and fractional plasma separation and adsorption with hemodialysis (Prometheus), have recently been developed to provide both renal and liver support in this group of patients. These are still considered experimental, although the MARS system has been utilized to treat patients with hepatorenal syndrome, and is available outside the United States.

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Section: Introductionmentioning

confidence: 99%

The Challenges of Providing Renal Replacement Therapy in Decompensated Liver Cirrhosis

Gonwa¹,

Wadei²

2012

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“…Continuous renal replacement therapy (CRRT) is often used to support these patients [15]. This modality of renal support provides enhanced hemodynamic tolerance, reduced risk of exacerbation of cerebral edema, along with superior metabolic, acid-base and azotemic control [16,17]. CRRT is now increasingly being utilized as intraoperative renal support for critically ill patients undergoing LT; however, there remains a paucity of available data describing this practice [12,17,18].…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort Study

Parmar

Bigam²,

Meeberg³

et al. 2011

Blood Purif

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Background: Intraoperative continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT). Our objective was to assess intraoperative CRRT for metabolic control, postoperative complications and outcomes. Methods: Retrospective matched cohort study. Cases were LT patients receiving intraoperative CRRT. Controls were matched for demographics and Model for End-Stage Liver Disease (MELD) score. Data were extracted on physiology, course and outcomes. Results: 72 patients were included. Despite effort to match by MELD, cases had higher scores (35.4 vs. 29.9, p = 0.01) compared to controls. Preoperatively, cases received more vasopressors (p = 0.006), and more RRT (94.4 vs. 25.7%, p < 0.0001). There was no difference in complications (p = 0.35) or ICU re-admission rate (p = 0.29). Cases were more likely to require postoperative RRT (p < 0.0001). There was no difference in hospital mortality (p = 0.61). Conclusions: LT patients selected for intraoperative CRRT more commonly have hemodynamic instability and preoperative acute kidney injury requiring RRT. Despite higher illness severity for cases, there were no differences in complications or mortality.

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“…This frequently requires renal replacement [66] with continuous (compared to intermittent) haemofiltration [69]. This avoids rapid water shifts seen with intermittent therapy [70], providing greater haemodynamic stability and improved cerebral perfusion pressure [69,71].…”

Section: Renal Supportmentioning

confidence: 99%

Management of Hepatic Encephalopathy

Plauth¹,

Merli²,

Kondrup³

1997

N Engl J Med

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Hepatic encephalopathy (HE), the neuropsychiatric presentation of liver disease, is associated with high morbidity and mortality. Reduction of plasma ammonia remains the central therapeutic strategy, but there is a need for newer novel therapies. We discuss current evidence supporting the use of interventions for both the general management of chronic HE and that necessary for more acute and advanced disease.

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Changes in Intracranial Pressure during Haemofiltration in Oliguric Patients with Grade IV Hepatic Encephalopathy

Cited by 66 publications

References 0 publications

The Challenges of Providing Renal Replacement Therapy in Decompensated Liver Cirrhosis

The Challenges of Providing Renal Replacement Therapy in Decompensated Liver Cirrhosis

An Evaluation of Intraoperative Renal Support during Liver Transplantation: A Matched Cohort Study

Management of Hepatic Encephalopathy

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