The Role of RRT in Hyperammonemic Patients

Abstract

Hyperammonemia is an important cause of cerebral edema in both adults with liver failure and children with inborn errors of metabolism. There are few studies that have analyzed the role of extracorporeal dialysis in reducing blood ammonia levels in the adult population. Furthermore, there are no firm guidelines about when to implement RRT, because many of the conditions that are characterized by hyperammonemia are extremely rare. In this review of existing literature on RRT, we present the body's own mechanisms for clearing ammonia as well as the dialytic properties of ammonia. We review the available literature on the use of continuous venovenous hemofiltration, peritoneal dialysis, and hemodialysis in neonates and adults with conditions characterized by hyperammonemia and discuss some of the controversies that exist over selecting one modality over another.

Differential response to renal replacement therapy in neonatal‐onset inborn errors of metabolism

“…For the latter purpose, RRT has been proposed since the late 70s for hyperammonemia and MSUD . During the last two decades, enormous technical and clinical improvements were achieved with different RRT methods, with the most published data on hyperammonemic patients, consistent with the favourable dialytic properties of ammonia …”

Late Presentation of Fatal Hyperammonemic Encephalopathy After Roux-En-Y Gastric Bypass

“…related to her late presentation, irreversible hyperammonemic eff ects on neurons, and brain parenchymal saturation ( 8 ).…”

Controversies Surrounding Renal Replacement Therapy in the Critically Ill Patient

“…51,52 Although guidelines do not exist, dialysis can be considered once the ammonia level is thrice the upper limit of normal or when the patient is showing signs of encephalopathy. 53 Timing of dialysis initiation is also debated in these patients. Some case series support early intervention with increased dialysis dosing.…”