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Title: Ammonia Clearance with Different Continuous Renal Replacement Therapy Techniques in Patients with Liver Failure.
Austin Authors: Fisher, Caleb ;Baldwin, Ian C ;Fealy, Nigel G ;Naorungroj, Thummaporn ;Bellomo, Rinaldo 
Affiliation: Intensive Care..
Data Analytics Research and Evaluation (DARE) Centre..
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia..
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia..
Issue Date: 18-Jan-2022
Date: 2022
Publication information: Blood Purification 2022; 51(10): 840-846
Abstract: Continuous renal replacement therapy (CRRT) can be used to treat hyperammonaemia. However, no study has assessed the effect of different CRRT techniques on ammonia clearance. We compared 3 different CRRT techniques in adult patients with hyperammonaemia, liver failure, and acute kidney injury. We protocolized CRRT to progressively deliver continuous veno-venous haemofiltration (CVVH), haemodialysis (CVVHD) or haemodiafiltration (CVVHDF). Ammonia was simultaneously sampled from the patient's arterial blood and effluent fluid for each technique. We applied accepted equations to calculate clearance. We studied 12 patients with a median age of 47 years (interquartile range [IQR] 25-79). Acute liver failure was present in 4 (25%) and acute-on-chronic liver failure in 8 (75%). There was no significant difference in median ammonia clearance between CRRT technique; CVVH: 27 (IQR 23-32) mL/min versus CVVHD: 21 (IQR 17-28) mL/min versus CVVHDF: 20 (IQR 14-28) mL/min, p = 0.32. Moreover, for all techniques, ammonia clearance was significantly less than urea and creatinine clearance; urea 50 (47-54) mL/min versus creatinine 42 (IQR 38-46) mL/min versus ammonia 25 (IQR 18-29) mL/min, p = 0.0001. We found no significant difference in ammonia clearance according to CRRT technique and demonstrated that ammonia clearance is significantly less than urea or creatinine clearance.
DOI: 10.1159/000521312
ORCID: 0000-0002-1650-8939
Journal: Blood purification
PubMed URL: 35042216
PubMed URL:
Type: Journal Article
Subjects: Ammonia
Critical illness
Liver disease
Renal replacement therapy
Appears in Collections:Journal articles

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