Please use this identifier to cite or link to this item:
Title: Correction and Control of Hyperammonemia in Acute Liver Failure: The Impact of Continuous Renal Replacement Timing, Intensity, and Duration.
Austin Authors: Warrillow, Stephen J ;Fisher, Caleb ;Bellomo, Rinaldo 
Affiliation: Critical Care Institute, Epworth HealthCare, Melbourne, Victoria, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
Intensive Care
Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
Issue Date: Feb-2020 2019-12-04
Publication information: Critical Care Medicine 2020; 48(2): 218-224
Abstract: Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continuous renal replacement therapy use in acute liver failure patients and to assess its impact on hyperammonemia. Retrospective observational study. ICU within a specialized liver transplant hospital. Fifty-four patients with acute liver failure. Data were obtained from medical records and analyzed for patient characteristics, continuous renal replacement therapy use, ammonia dynamics, and outcomes. Forty-five patients (83%) had high grade encephalopathy. Median time to continuous renal replacement therapy commencement was 4 hours (interquartile range, 2-4.5) with 35 (78%) treated with continuous venovenous hemodiafiltration and 10 (22%) with continuous venovenous hemofiltration. Median hourly effluent flow rate was 43 mL/kg (interquartile range, 37-62). The median ammonia concentration decreased every day during treatment from 151 µmol/L (interquartile range, 110-204) to 107 µmol/L (interquartile range, 84-133) on day 2, 75 µmol/L (interquartile range, 63-95) on day 3, and 52 µmol/L (interquartile range, 42-70) (p < 0.0001) on day 5. The number of patients with an ammonia level greater than 150 µmol/L decreased on the same days from 26, to nine, then two, and finally none. Reductions in ammonia levels correlated best with the cumulative duration of therapy hours (p = 0.03), rather than hourly treatment intensity. Continuous renal replacement therapy is associated with reduced ammonia concentrations in acute liver failure patients. This effect is related to greater cumulative dose. These findings suggest that continuous renal replacement therapy initiated early and continued or longer may represent a useful approach to hyperammonemia control in acute liver failure patients.
DOI: 10.1097/CCM.0000000000004153
ORCID: 0000-0002-1650-8939
PubMed URL: 31939790
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Dec 4, 2022

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.