Continuous renal replacement therapy is associated with reduced serum ammonia levels and mortality in acute liver failure

Abstract

In a large cohort of ALF patients, hyperammonemia was associated with high-grade HE and worse 21-day TFS. CRRT was associated with a reduction in serum ammonia level and improvement of 21-day TFS. (Hepatology 2017).

Living Donor Liver Transplantation for Acute Liver Failure: Donor Safety and Recipient Outcome

“…A study from the US Acute Liver Failure Study Group had 61 patients on CRRT. After adjusting for other factors, CRRT use on day 1 was significantly associated with lower 21‐day poststudy, transplant‐free, all‐cause mortality (adjusted odds ratio of 0.47 [95% CI, 0.26‐0.82]) and reduced ammonia levels . In the current series, the use of CRRT and plasmapheresis was particularly low during the study period.…”

“…After adjusting for other factors, CRRT use on day 1 was significantly associated with lower 21-day poststudy, transplant-free, all-cause mortality (adjusted odds ratio of 0.47 [95% CI, 0.26-0.82]) and reduced ammonia levels. (43) In the current series, the use of CRRT and plasmapheresis was particularly low during the study period. More recently, we started using plasmapheresis and CRRT more frequently, and we have seen some beneficial effect.…”

“…It has been shown that an ammonia level more than 123 µg/dL is associated with a higher level of encephalopathy and severe CE, and it is an independent predictor of mortality. (41) More recently, there has been some evidence that ammonia-lowering strategies, such as plasmapheresis (42) or continuous renal replacement therapy (CRRT), (43) are a benefit in patients with ALF in terms of lowering CE, decreasing multiorgan dysfunction, and improving transplant-free survival. A large randomized controlled trial with 182 patients showed overall hospital survival of 58.7% for patients treated with plasmapheresis versus 47.8% for the control group (P = 0.008) with stratification for LT in patients with ALF.…”

Response to: Is high volume Haemofiltration really necessary to remove Ammonia?

“…The large retrospective study from the USALF study group found at as compared to CVVHF, IHD failed to lower circulating ammonia concentrations and was associated with increased mortality. 4 The use of continuous rather than intermittent forms of RRT in patients with ALF is now advised in the Clinical Practice Guidelines for ALF from the European Association for the Study of Liver Disease. 5 Andrew J.…”

A Role of Renal Replacement Therapy for Acute Liver Failure

“…

We read with interest the article by Cardoso et al, (1) who reported that continuous renal replacement therapy for acute liver failure (ALF) was associated with a reduction in serum ammonia level and improved 21-day transplant-free survival in a large, multicenter study.First of all, we applaud their efforts for the diagnosis and treatment of ALF and continuous contributions targeting whole fields of ALF as the U.S. ALF Study Group, different from the Japanese one. We realize how difficult these studies are to perform in infrequent and life-threatening diseases like ALF.We also believe an artificial liver support system sustaining patients in good condition, including restoration of consciousness until recovery of the native liver or performance of liver transplantation, is essential for the improvement of the poor prognosis of ALF, although it does not induce liver regeneration.

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