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Ammonia clearance with haemofiltration in adults with liver disease
Background & Aims Ammonia is recognized as a toxin central to complications of liver failure. Hyperammonaemia has important clinical consequences, but optimal means to reduce circulating levels are uncertain. In patients with liver disease, continuous renal replacement therapy (CRRT) with haemof...
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| Published in: | Liver international 2014-01, Vol.34 (1), p.42-48 |
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| cites | cdi_FETCH-LOGICAL-c3631-d657d32f2dd3ccd31d14f4f06a18a6b57b2d8e96e451b6b4dbad12efe709a09d3 |
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| container_title | Liver international |
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| creator | Slack, Andrew J. Auzinger, Georg Willars, Chris Dew, Tracy Musto, Rebecca Corsilli, Daniel Sherwood, Roy Wendon, Julia A. Bernal, William |
| description | Background & Aims
Ammonia is recognized as a toxin central to complications of liver failure. Hyperammonaemia has important clinical consequences, but optimal means to reduce circulating levels are uncertain. In patients with liver disease, continuous renal replacement therapy (CRRT) with haemofiltration (HF) is often required to treat concurrent kidney injury, but its effects upon ammonia levels are poorly characterized. To evaluate the effect of HF at different treatment intensities on ammonia clearance (AC) and arterial ammonia concentration.
Methods
Prospective study of adult patients with liver failure and arterial ammonia >100 μmol/L requiring CRRT using veno‐venous HF. Arterial ammonia concentration and AC measured at 1 and 24 h after initiation of low (35 ml/kg/h) or high (90 ml/kg/h) filtration volume.
Results
Twenty‐four patients (10 acute liver failure, 10 chronic liver disease and 4 following liver resection) were studied. Clearance of urea and ammonia solutes correlated closely (r = 0.819, P = 0.007). Ammonia clearance correlated closely with ultrafiltration rate (r = 0.86, P |
| doi_str_mv | 10.1111/liv.12221 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1467067900</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1467067900</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3631-d657d32f2dd3ccd31d14f4f06a18a6b57b2d8e96e451b6b4dbad12efe709a09d3</originalsourceid><addsrcrecordid>eNp1kMtOwzAQRS0EoqWw4AdQlrBI60diJ8uqglIpgiLxWFpOPFENeRQ7ofTvCaTtjtnMSHPuHc1F6JLgMelqUpivMaGUkiM0JIGIfEYZOT7MlA3QmXPvGJM4DskpGlAmIh6yaIhm07KsK6O8rABlVZWBtzHNylspKOvcFI1Vjakrz1Se0m3RuH7dXQTraeNAOThHJ7kqHFzs-gi93N0-z-795HG-mE0TP2OcEV_zUGhGc6o1yzLNiCZBHuSYKxIpnoYipTqCmEMQkpSngU6VJhRyEDhWONZshK5737WtP1twjSyNy6AoVAV16yQJuMBcxBh36E2PZrZ2zkIu19aUym4lwfI3M9l9IP8y69irnW2blqAP5D6kDpj0wMYUsP3fSSaL172l3yuMa-D7oFD2Q3LBRCjfHuYypMunZRgkUrAf5pSFNw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1467067900</pqid></control><display><type>article</type><title>Ammonia clearance with haemofiltration in adults with liver disease</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Slack, Andrew J. ; Auzinger, Georg ; Willars, Chris ; Dew, Tracy ; Musto, Rebecca ; Corsilli, Daniel ; Sherwood, Roy ; Wendon, Julia A. ; Bernal, William</creator><creatorcontrib>Slack, Andrew J. ; Auzinger, Georg ; Willars, Chris ; Dew, Tracy ; Musto, Rebecca ; Corsilli, Daniel ; Sherwood, Roy ; Wendon, Julia A. ; Bernal, William</creatorcontrib><description>Background & Aims
Ammonia is recognized as a toxin central to complications of liver failure. Hyperammonaemia has important clinical consequences, but optimal means to reduce circulating levels are uncertain. In patients with liver disease, continuous renal replacement therapy (CRRT) with haemofiltration (HF) is often required to treat concurrent kidney injury, but its effects upon ammonia levels are poorly characterized. To evaluate the effect of HF at different treatment intensities on ammonia clearance (AC) and arterial ammonia concentration.
Methods
Prospective study of adult patients with liver failure and arterial ammonia >100 μmol/L requiring CRRT using veno‐venous HF. Arterial ammonia concentration and AC measured at 1 and 24 h after initiation of low (35 ml/kg/h) or high (90 ml/kg/h) filtration volume.
Results
Twenty‐four patients (10 acute liver failure, 10 chronic liver disease and 4 following liver resection) were studied. Clearance of urea and ammonia solutes correlated closely (r = 0.819, P = 0.007). Ammonia clearance correlated closely with ultrafiltration rate (r = 0.86, P < 0.001). At 1 h, AC was 39 (34–54) ml/min (low volume) vs 85 (62–105) ml/min (high volume) CRRT, (P < 0.001) and at 24 h 44 (34–63) vs 105 (82–109) ml/min, (P = 0.01). Overall, a 22% reduction in median arterial ammonia concentration was observed over 24 h of HF from 156 (137–176) to 122 (85–133) μmol/L, (P ≤ 0.0001).
Conclusion
Clinically significant ammonia clearance can be achieved in adult patients with hyperammonaemia utilizing continuous VVHF. Ammonia clearance is closely correlated with ultrafiltration rate. HF was associated with a fall in arterial ammonia concentration.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.12221</identifier><identifier>PMID: 23786538</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; Ammonia - blood ; ammonia clearance ; Cordoba equation ; Female ; haemofiltration ; Hemodiafiltration ; Humans ; hyperammonaemia ; Hyperammonemia - blood ; Hyperammonemia - diagnosis ; Hyperammonemia - therapy ; Liver Failure - blood ; Liver Failure - diagnosis ; Liver Failure - therapy ; Male ; Middle Aged ; Models, Biological ; Prospective Studies ; Time Factors ; Treatment Outcome ; ultrafiltration rate ; Urea - blood</subject><ispartof>Liver international, 2014-01, Vol.34 (1), p.42-48</ispartof><rights>2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3631-d657d32f2dd3ccd31d14f4f06a18a6b57b2d8e96e451b6b4dbad12efe709a09d3</citedby><cites>FETCH-LOGICAL-c3631-d657d32f2dd3ccd31d14f4f06a18a6b57b2d8e96e451b6b4dbad12efe709a09d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23786538$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Slack, Andrew J.</creatorcontrib><creatorcontrib>Auzinger, Georg</creatorcontrib><creatorcontrib>Willars, Chris</creatorcontrib><creatorcontrib>Dew, Tracy</creatorcontrib><creatorcontrib>Musto, Rebecca</creatorcontrib><creatorcontrib>Corsilli, Daniel</creatorcontrib><creatorcontrib>Sherwood, Roy</creatorcontrib><creatorcontrib>Wendon, Julia A.</creatorcontrib><creatorcontrib>Bernal, William</creatorcontrib><title>Ammonia clearance with haemofiltration in adults with liver disease</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background & Aims
Ammonia is recognized as a toxin central to complications of liver failure. Hyperammonaemia has important clinical consequences, but optimal means to reduce circulating levels are uncertain. In patients with liver disease, continuous renal replacement therapy (CRRT) with haemofiltration (HF) is often required to treat concurrent kidney injury, but its effects upon ammonia levels are poorly characterized. To evaluate the effect of HF at different treatment intensities on ammonia clearance (AC) and arterial ammonia concentration.
Methods
Prospective study of adult patients with liver failure and arterial ammonia >100 μmol/L requiring CRRT using veno‐venous HF. Arterial ammonia concentration and AC measured at 1 and 24 h after initiation of low (35 ml/kg/h) or high (90 ml/kg/h) filtration volume.
Results
Twenty‐four patients (10 acute liver failure, 10 chronic liver disease and 4 following liver resection) were studied. Clearance of urea and ammonia solutes correlated closely (r = 0.819, P = 0.007). Ammonia clearance correlated closely with ultrafiltration rate (r = 0.86, P < 0.001). At 1 h, AC was 39 (34–54) ml/min (low volume) vs 85 (62–105) ml/min (high volume) CRRT, (P < 0.001) and at 24 h 44 (34–63) vs 105 (82–109) ml/min, (P = 0.01). Overall, a 22% reduction in median arterial ammonia concentration was observed over 24 h of HF from 156 (137–176) to 122 (85–133) μmol/L, (P ≤ 0.0001).
Conclusion
Clinically significant ammonia clearance can be achieved in adult patients with hyperammonaemia utilizing continuous VVHF. Ammonia clearance is closely correlated with ultrafiltration rate. HF was associated with a fall in arterial ammonia concentration.</description><subject>Adult</subject><subject>Ammonia - blood</subject><subject>ammonia clearance</subject><subject>Cordoba equation</subject><subject>Female</subject><subject>haemofiltration</subject><subject>Hemodiafiltration</subject><subject>Humans</subject><subject>hyperammonaemia</subject><subject>Hyperammonemia - blood</subject><subject>Hyperammonemia - diagnosis</subject><subject>Hyperammonemia - therapy</subject><subject>Liver Failure - blood</subject><subject>Liver Failure - diagnosis</subject><subject>Liver Failure - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>Prospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>ultrafiltration rate</subject><subject>Urea - blood</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp1kMtOwzAQRS0EoqWw4AdQlrBI60diJ8uqglIpgiLxWFpOPFENeRQ7ofTvCaTtjtnMSHPuHc1F6JLgMelqUpivMaGUkiM0JIGIfEYZOT7MlA3QmXPvGJM4DskpGlAmIh6yaIhm07KsK6O8rABlVZWBtzHNylspKOvcFI1Vjakrz1Se0m3RuH7dXQTraeNAOThHJ7kqHFzs-gi93N0-z-795HG-mE0TP2OcEV_zUGhGc6o1yzLNiCZBHuSYKxIpnoYipTqCmEMQkpSngU6VJhRyEDhWONZshK5737WtP1twjSyNy6AoVAV16yQJuMBcxBh36E2PZrZ2zkIu19aUym4lwfI3M9l9IP8y69irnW2blqAP5D6kDpj0wMYUsP3fSSaL172l3yuMa-D7oFD2Q3LBRCjfHuYypMunZRgkUrAf5pSFNw</recordid><startdate>201401</startdate><enddate>201401</enddate><creator>Slack, Andrew J.</creator><creator>Auzinger, Georg</creator><creator>Willars, Chris</creator><creator>Dew, Tracy</creator><creator>Musto, Rebecca</creator><creator>Corsilli, Daniel</creator><creator>Sherwood, Roy</creator><creator>Wendon, Julia A.</creator><creator>Bernal, William</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201401</creationdate><title>Ammonia clearance with haemofiltration in adults with liver disease</title><author>Slack, Andrew J. ; Auzinger, Georg ; Willars, Chris ; Dew, Tracy ; Musto, Rebecca ; Corsilli, Daniel ; Sherwood, Roy ; Wendon, Julia A. ; Bernal, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3631-d657d32f2dd3ccd31d14f4f06a18a6b57b2d8e96e451b6b4dbad12efe709a09d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Ammonia - blood</topic><topic>ammonia clearance</topic><topic>Cordoba equation</topic><topic>Female</topic><topic>haemofiltration</topic><topic>Hemodiafiltration</topic><topic>Humans</topic><topic>hyperammonaemia</topic><topic>Hyperammonemia - blood</topic><topic>Hyperammonemia - diagnosis</topic><topic>Hyperammonemia - therapy</topic><topic>Liver Failure - blood</topic><topic>Liver Failure - diagnosis</topic><topic>Liver Failure - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Biological</topic><topic>Prospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>ultrafiltration rate</topic><topic>Urea - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Slack, Andrew J.</creatorcontrib><creatorcontrib>Auzinger, Georg</creatorcontrib><creatorcontrib>Willars, Chris</creatorcontrib><creatorcontrib>Dew, Tracy</creatorcontrib><creatorcontrib>Musto, Rebecca</creatorcontrib><creatorcontrib>Corsilli, Daniel</creatorcontrib><creatorcontrib>Sherwood, Roy</creatorcontrib><creatorcontrib>Wendon, Julia A.</creatorcontrib><creatorcontrib>Bernal, William</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Slack, Andrew J.</au><au>Auzinger, Georg</au><au>Willars, Chris</au><au>Dew, Tracy</au><au>Musto, Rebecca</au><au>Corsilli, Daniel</au><au>Sherwood, Roy</au><au>Wendon, Julia A.</au><au>Bernal, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ammonia clearance with haemofiltration in adults with liver disease</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2014-01</date><risdate>2014</risdate><volume>34</volume><issue>1</issue><spage>42</spage><epage>48</epage><pages>42-48</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background & Aims
Ammonia is recognized as a toxin central to complications of liver failure. Hyperammonaemia has important clinical consequences, but optimal means to reduce circulating levels are uncertain. In patients with liver disease, continuous renal replacement therapy (CRRT) with haemofiltration (HF) is often required to treat concurrent kidney injury, but its effects upon ammonia levels are poorly characterized. To evaluate the effect of HF at different treatment intensities on ammonia clearance (AC) and arterial ammonia concentration.
Methods
Prospective study of adult patients with liver failure and arterial ammonia >100 μmol/L requiring CRRT using veno‐venous HF. Arterial ammonia concentration and AC measured at 1 and 24 h after initiation of low (35 ml/kg/h) or high (90 ml/kg/h) filtration volume.
Results
Twenty‐four patients (10 acute liver failure, 10 chronic liver disease and 4 following liver resection) were studied. Clearance of urea and ammonia solutes correlated closely (r = 0.819, P = 0.007). Ammonia clearance correlated closely with ultrafiltration rate (r = 0.86, P < 0.001). At 1 h, AC was 39 (34–54) ml/min (low volume) vs 85 (62–105) ml/min (high volume) CRRT, (P < 0.001) and at 24 h 44 (34–63) vs 105 (82–109) ml/min, (P = 0.01). Overall, a 22% reduction in median arterial ammonia concentration was observed over 24 h of HF from 156 (137–176) to 122 (85–133) μmol/L, (P ≤ 0.0001).
Conclusion
Clinically significant ammonia clearance can be achieved in adult patients with hyperammonaemia utilizing continuous VVHF. Ammonia clearance is closely correlated with ultrafiltration rate. HF was associated with a fall in arterial ammonia concentration.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>23786538</pmid><doi>10.1111/liv.12221</doi><tpages>7</tpages></addata></record> |
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| ispartof | Liver international, 2014-01, Vol.34 (1), p.42-48 |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Adult Ammonia - blood ammonia clearance Cordoba equation Female haemofiltration Hemodiafiltration Humans hyperammonaemia Hyperammonemia - blood Hyperammonemia - diagnosis Hyperammonemia - therapy Liver Failure - blood Liver Failure - diagnosis Liver Failure - therapy Male Middle Aged Models, Biological Prospective Studies Time Factors Treatment Outcome ultrafiltration rate Urea - blood |
| title | Ammonia clearance with haemofiltration in adults with liver disease |
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