A Role of Renal Replacement Therapy for Acute Liver Failure

Hepatology ◽  
2018 ◽  
Vol 68 (3) ◽  
pp. 1204-1204 ◽  
Author(s):  
Keiichi Fujiwara ◽  
Shin Yasui ◽  
Osamu Yokosuka ◽  
Shigeto Oda ◽  
Naoya Kato
Keyword(s):  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Replacement Therapy

Expanding the Boundaries of Combined Renal Replacement Therapy for Non-Renal Indications

2018 ◽  
Vol 47 (1-3) ◽  
pp. 69-72 ◽  
Author(s):  
Mayanka Kamboj ◽  
Amir Kazory
Keyword(s):  
Hepatic Encephalopathy ◽  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Replacement Therapy ◽  
Ammonia Level ◽  
Clinical Aspects ◽  
Optimal Timing ◽  
The Impact

Over the last decades, there have been major advancements in the field of renal replacement therapy (RRT) with utilization of newer technologies and advent of various modalities. Once exclusively used for treatment of renal failure and its metabolic consequences, the science of RRT has expanded to include non-renal indications such as treatment of fluid overload in patients with refractory heart failure. Hepatic encephalopathy due to sudden rise in serum ammonia level in the setting of acute liver failure represents an underexplored area in which RRT can potentially be helpful. While the key role of hyperammonemia in the pathogenesis of hepatic encephalopathy in patients with liver failure is well established, emerging data points to distinct pathophysiologic mechanisms underlying chronic alterations in neural metabolic functions and acute changes in cerebral perfusion. In the acute setting, ammonia can cross the blood–brain barrier at high levels leading to sudden formation of strong osmolytes, significant transcellular shift of water, and cerebral edema. Herein, we provide a brief overview of the role of RRT in management of acute hyperammonemia in the setting of acute liver failure and discuss the practical aspects of the available therapeutic modalities. Larger studies are needed to shed light on a number of clinical aspects such as the impact on the outcomes, criteria for selection of the patients that would benefit most from this therapeutic approach, optimal timing of initiation of RRT, and the most appropriate modality.

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

Hepatology ◽  
2017 ◽  
Vol 67 (2) ◽  
pp. 711-720 ◽  
Author(s):  
Filipe S. Cardoso ◽  
Michelle Gottfried ◽  
Shannan Tujios ◽  
Jody C. Olson ◽  
Constantine J. Karvellas ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Serum Ammonia

Effect of Continuous Renal Replacement Therapy on Outcome in Pediatric Acute Liver Failure

2017 ◽  
Vol 45 (5) ◽  
pp. e534-e535 ◽  
Author(s):  
Puneet Jain ◽  
Ramachandran Rameshkumar ◽  
Ponnarmeni Satheesh ◽  
Subramanian Mahadevan
Keyword(s):  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Pediatric Acute Liver Failure

scholarly journals Continuous renal replacement therapy and its impact on hyperammonaemia in acute liver failure

2020 ◽  
Vol 22 (2) ◽  
pp. 158-165
Author(s):  
Stephen Warrillow ◽  
◽  
Caleb Fisher ◽  
Heath Tibballs ◽  
Michael Bailey ◽  
...  
Keyword(s):  
New Zealand ◽  
Renal Replacement Therapy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Ammonia Concentration ◽  
Free Survival ◽  
Stage 1

Objective: Hyperammonaemia contributes to complications in acute liver failure (ALF) and may be treated with continuous renal replacement therapy (CRRT), but current practice is poorly understood. Design: We retrospectively analysed data for baseline characteristics, ammonia concentration, CRRT use, and outcomes in a cohort of Australian and New Zealand patients with ALF. Setting: All liver transplant ICUs across Australia and New Zealand. Participants: Sixty-two patients with ALF. Main outcome measures: Impact of CRRT on hyperammonaemia and patient outcomes. Results: We studied 62 patients with ALF. The median initial (first 24 h) peak ammonia was 132 mol/L (interquartile range [IQR], 91–172), median creatinine was 165 mol/L (IQR, 92–263) and median urea was 6.9 mmol/L (IQR, 3.1–12.0). Most patients (43/62, 69%) received CRRT within a median of 6 hours (IQR, 2–12) of ICU admission. At CRRT commencement, three-quarters of such patients did not have Stage 3 acute kidney injury (AKI): ten patients (23%) had no KDIGO creatinine criteria for AKI, 12 (28%) only had Stage 1, and ten patients (23%) had Stage 2 AKI. Compared with non-CRRT patients, those treated with CRRT had higher ammonia concentrations (median, 141 mol/L [IQR, 102–198] v 91 mol/L [IQR, 54–115]; P = 0.02), but a nadir Day 1 pH of only 7.25 (standard deviation, 0.16). Prevention of extreme hyperammonaemia (> 140 mol/L) after Day 1 was achieved in 36 of CRRT-treated patients (84%) and was associated with transplant-free survival (55% v 13%; P = 0.05). Conclusion: In Australian and New Zealand patients with ALF, CRRT is typically started early, before Stage 3 AKI or severe acidaemia, and in the presence hyperammonaemia. In these more severely ill patients, CRRT use was associated with prevention of extreme hyperammonaemia, which in turn, was associated with increased transplant-free survival.

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