Role of Sustained Low-Efficiency Dialysis (SLED) in HyperammoniaPatients with Hepatic Encephalopathy

Authors

Abstract

Objective: To assess the role of sustained low-efficiency dialysis (SLED) in patients with hyperammonia secondary to liver failure.

Methods

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 <145 μg/dL (85 μmol/L) twice, 12–24 hours apart, with neurological improvement.

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.

Published

2025/03/10

Issue

Vol. -ISSUE 1

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