JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v6i1.2514 jpsim.v6i1.2514 Original Research Role of Sustained Low-Efficiency Dialysis (SLED) in Hyperammonia Patients with Hepatic Encephalopathy Sharieff Saleem ssharieff@live.ca * Rafai Wajid Ali Manzoor Adil Asad Ahsen Gulraiz Mahrukh Rai Hamna Sawaiba Pakistan Kidney and Liver Institute and Research Centre (PKLI-RC), Lahore, Pakistan *Correspondence: Saleem Sharieff (ssharieff@live.ca) 10 03 2025 2025 6 1 65 70 30 04 2024 30 01 2025 22 02 2025 Copyright © 2025 The Author(s) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To observe sustained low-efficiency dialysis (SLED) in patients with hyperammonia secondary to liver failure.

 Methodology

In this retrospective study, 20 patients with hepatic encephalopathy from hyperammonia secondary to liver failure (14 with ACLF and 6 with ALF) were offered SLED. The study excluded pediatric patients and those with normal ammonia or without hepatic encephalopathy. Data collected included demographics, diagnosis, lab results, APACHE II/SOFA scores, and outcomes. Ammonia levels were monitored before and during SLED. Success was defined by ammonia reduction and clinical improvement.

The SLED protocol used a 300 mL/min dialysate flow, 100–200 mL/min blood flow, and ultrafiltration of 0–2500 mL/session for 6–8 hours daily. SLED was stopped when ammonia remained

 Results

The mean age was 41 ± 14.5. A total of 9 patients survived (3 ALF and 6 ACLF) with an overall mortality rate of 55%. Low Hb, albumin and high SOFA scores were found to be poor prognostic markers.

 Conclusion

Hyperammonia causing hepatic encephalopathy in liver failure carries a high mortality rate and requires prompt lowering of the ammonia level to prevent brain damage. SLED can be considered in lowering ammonia level. Large-scale studies are required to further assess efficacy of SLED in treating hyperammonia.

 Keywords Sustained low-efficiency dialysis (SLED) hyperammonia Hepatic encephalopathy liver failure. Ethics Statement

Ethics committee: Institutional Review Board, Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan. Approval number: PKLI-IRB/AP/138, dated 31-07-2023.

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