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dc.contributor.authorNaorungroj, Thummaporn-
dc.contributor.authorYanase, Fumitaka-
dc.contributor.authorEastwood, Glenn M-
dc.contributor.authorBaldwin, Ian C-
dc.contributor.authorBellomo, Rinaldo-
dc.identifier.citationBlood Purification 2020; online first: 4 Decemberen
dc.description.abstractIntroduction: Hyperammonemia is a life-threatening condition. However, clearance of ammonia via extracorporeal treatment has not been systematically evaluated. Methods: We searched EMBASE and MEDLINE databases. We included all publications reporting ammonia clearance by extracorporeal treatment in adult and pediatric patients with clearance estimated by direct dialysate ammonia measurement or calculated by formula. Two reviewers screened and extracted data independently. Results: We found 1,770 articles with 312 appropriate for assessment and 28 studies meeting eligibility criteria. Most of the studies were case reports. Hyperammonemia was typically secondary to inborn errors of metabolisms in children and to liver failure in adult patients. Ammonia clearance was most commonly reported during continuous renal replacement therapy (CRRT) and appeared to vary markedly from <5 mL/min/m2 to >250 mL/min/m2. When measured during intermittent hemodialysis (IHD), clearance was highest and correlated with blood flow rate (R2 = 0.853; p < 0.001). When measured during CRRT, ammonia clearance could be substantial and correlated with effluent flow rate (EFR; R2 = 0.584; p < 0.001). Neither correlated with ammonia reduction. Peritoneal dialysis (PD) achieved minimal clearance, and other extracorporeal techniques were rarely studied. Conclusions: Extracorporeal ammonia clearance varies widely with sometimes implausible values. Treatment modality, blood flow, and EFR, however, appear to affect such clearance with IHD achieving the highest values, PD achieving minimal values, and CRRT achieving substantial values especially at high EFRs. The role of other techniques remains unclear. These findings can help inform practice and future studies.en
dc.subjectContinuous renal replacement therapyen
dc.subjectInborn errors of metabolismen
dc.subjectLiver failureen
dc.subjectUrea cycleen
dc.titleExtracorporeal Ammonia Clearance for Hyperammonemia in Critically Ill Patients: A Scoping Reviewen
dc.typeJournal Articleen
dc.identifier.journaltitleBlood Purificationen
dc.identifier.affiliationIntensive Careen
dc.identifier.affiliationDepartment of Intensive Care, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.en
dc.identifier.affiliationCentre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationData Analytics Research and Evaluation (DARE) Centreen
dc.type.studyortrialReviews/Systematic Reviewsen
dc.type.austinJournal Articleen
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