Title: Continuous kidney replacement therapy for management of hyperammonemia and hepatic encephalopathy in pediatric acute liver failure
Source: Journal of Pediatric Gastroenterology and Nutrition 2025, Oct 13. [E–publication]
Date of publication: October 2025
Publication type: Retrospective analysis
Abstract: Objectives: This study aimed to evaluate the impact of continuous kidney replacement therapy (CKRT) on the outcomes of pediatric acute liver failure (PALF).
Methods: This was a retrospective analysis of PALF presenting to a tertiary care pediatric hepatology center between January 2012 and August 2024. Cases of PALF where CKRT was initiated within 24 h of admission for nonrenal indications (hyperammonemia, hepatic encephalopathy [HE]) were identified and outcomes compared to a propensity-matched cohort of controls not receiving CKRT. The primary outcome measures were native liver survival (NLS) and overall survival (OS) at Day 28.
Results: A total of 448 patients with PALF were admitted during the study period, of which 94 had received CKRT. Thirty-eight (40.4%) of them who received CKRT for renal indications were excluded. The remaining 56 (59.6%) received CKRT for hyperammonemia and HE. The NLS in the CKRT and no CKRT groups were 46.4%, and 52.1%, respectively, while the OS in the two groups was 53.6%, and 61.3%, respectively. In the propensity-matched cohort (52 in each arm), there was a statistically insignificant trend toward higher NLS (46.2% vs. 36.5%, p = 0.304) and OS (53.8% vs. 44.2%, p = 0.291) in CKRT group compared to controls. Patients receiving CKRT had lower ammonia (p = 0.016) and bilirubin (p = 0.008) levels on Day 4, while international normalized ratio and lactate levels remained comparable.
Conclusion: CKRT led to significant reduction in ammonia on Day 4 in PALF; however, this did not translate into improved NLS and OS.
