Simultaneous Double Hemodialysis for the Control of Refractory Hyperammonemia

Abstract

Simultaneous double hemodialysis may be used as an important adjunct in treating refractory hyperammonemia.

Aggressive Plasmablastic Myeloma With Extramedullary Cord Compression and Hyperammonemic Encephalopathy: Case Report and Literature Review

“…These patients were going to begin chemotherapy anyway, suggesting that addressing the underlying malignancy had an overall beneficial effect. Nonetheless, other reports have demonstrated an equally beneficial role of hemodialysis in achieving full recovery, even in those with refractory MM-induced hyperammonemia (36). Unfortunately, our patient did not want to undergo any further treatments.…”

Multiple Myeloma-Induced Hyperammonemic Encephalopathy

“…Some studies report beneficial effects in using hemodialysis to remove excess ammonia [9,10]. Several others suggest that the initiation of aggressive chemotherapy is the most effective measure to achieve normal ammonia levels and clinical improvement [7].…”

“…The etiology of this disease has yet to be determined. Currently, there is no consensus on management (Table 1) [7][8][9].…”

Role of RRT in Adult Patients with Hyperammonemia

“…At a dialysate flow rate of 800 ml/min, a further degree of ammonia clearance was observed with increasing blood flow rate but no plateau was observed within the range of the blood flow rate used. In other words, with a blood flow rate of 200 to 300 ml/min and a dialysate flow rate of 800 ml/min, a rate of ammonia extraction of up to 99% can be seen if there is no ongoing generation of ammonia [12,13]. The influence of the dialyzer surface area on ammonia clearance depends on the blood flow rate.…”

“…Treatment of hyperammonemia in such patients is by treating the underlying multiple myeloma, which will lead to a sustained and rapid reduction in the ammonia level as well as an improvement in the mental status [8,13,26]. Data about the role of RRT suggests that dialysis plays only a minor role in lowering ammonia in this patient population [26].…”