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