Continuous Renal Replacement Therapy Intensity in Hyperammonemia

Launched by HOSPITAL DE CLINICAS DE PORTO ALEGRE · May 16, 2025

Keywords

ClinConnect Summary

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are critical conditions characterized by rapid deterioration in hepatic function, coagulopathy, hepatic encephalopathy, and multi-organ failure. Elevated serum ammonia levels are frequently observed in these patients and are strongly associated with cerebral dysfunction, including coma and delirium. Ammonia contributes to the development of brain edema through mechanisms involving astrocyte swelling, oxidative stress, and altered neurotransmission. Rapid and effective reduction of ammonia is a key therapeutic target in the ...

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Eligibility criteria

• Inclusion Criteria:
• • Age ≥ 18 years
• • Diagnosis of acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) Presence of hyperammonemia, defined as: Arterial ammonia \>72 μmol/L and hepatic encephalopathy grade ≥2 or Arterial ammonia \>100 μmol/L regardless of encephalopathy grade
• • Indication for continuous renal replacement therapy (CRRT), as determined by the attending medical team
• • Informed consent provided by the patient or legal representative
• Exclusion Criteria:
• • Age \< 18 years
• • Pregnancy
• • Diagnosis of acute liver failure (ALF) in the context of severe hemodynamic instability
• • ALF secondary to ischemic hepatic injury