Continuous Renal Replacement Therapy Intensity in Hyperammonemia

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are life-threatening conditions often associated with hyperammonemia, hepatic encephalopathy, and multi-organ dysfunction. Ammonia plays a central role in the pathogenesis of cerebral edema and neurotoxicity. Continuous renal replacement therapy (CRRT) has been shown to effectively reduce serum ammonia levels and may improve transplant-free survival in ALF. However, the optimal dialysis dose for ammonia clearance and neurological recovery remains uncertain. This randomized, multicenter clinical trial aims to compare conventional-dose (25-35 mL/kg/h) versus high-dose (45-55 mL/kg/h) CRRT in patients with ALF or ACLF and arterial ammonia \>72 μmol/L. The primary outcome is the number of coma- and delirium-free days. Secondary outcomes include ammonia clearance and additional parameters of cerebral function monitoring.

NCT Number	NCT06987604
Lead Sponsor	Hospital de Clinicas de Porto Alegre Collaborators: FIPE - Fundo de Incentivo a Pesquisa do Hospital de Clínicas de Porto Alegre
Conditions	Acute Liver Failure, Acute on Chronic Liver Failure (ACLF), Acute Kidney Injury, Ammonia Metabolism
Enrollment	152 participants
Start Date	2025-03-14
Primary Completion	2029-05-14 (estimated)
Study Completion	2029-05-14 (estimated)
Updated on ClinicalTrials.gov	2025-06-24