Abstract: SA-PO0353
Effect of Early vs. Delayed Kidney Replacement Therapy on Hyperammonemia in Patients with Cirrhosis
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Rabbani, Haziq H., Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, United States
- Subhash, Sanat, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, United States
- Pantelakis, Nicholas James, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, United States
- Gudsoorkar, Prakash Shashikant, University of Cincinnati, Cincinnati, Ohio, United States
- Raina, Rupesh, Akron Children's Hospital, Akron, Ohio, United States
Background
In decompensated cirrhosis, hyperammonemia and hepatic encephalopathy (HE) are major contributors to adverse outcomes. Renal replacement therapy (RRT) may be a secondary intervention; however, the optimal timing of RRT initiation remains unclear. This study assesses how early vs delayed RRT initiation affects hyperammonemia, HE progression, and clinical outcomes in critically ill cirrhotic patients.
Methods
In this retrospective cohort study, electronic health records from the TriNetX database were analyzed for cirrhotic ICU patients categorized into early RRT, delayed RRT, and no RRT (Figure 1). Cohorts were propensity matched based on demographics, disease severity, and baseline organ function. Primary outcomes evaluated were hyperammonemia [≥50 μmol/L (RI: 11 to 50 µmol/L)] and HE (graded by West Haven criteria). Secondary outcomes included mortality, ventilation, liver transplantation, cerebral edema, esophageal varices, hemorrhage, and healthcare resource utilization, assessed at 30- and 90-day post-admission.
Results
Early RRT and delayed RRT both significantly reduced hyperammonemia risk at 90 days. Early RRT increased HE risk at 30 days, while delayed RRT increased HE risk at both 30 days and 90 days. Both RRT groups exhibited higher mortality and ventilation rates than controls. Delayed RRT significantly increased liver transplantation risk at 30 days and 90 days, whereas early RRT showed elevated risk only at 90 days.
Conclusion
Early initiation of RRT reduces hyperammonemia and long-term HE progression risks but is associated with increased short-term HE risks. Delayed RRT, however, fails to consistently reduce hyperammonemia and increases risks for long-term HE, liver transplantation, cerebral edema, hemorrhage, and esophageal varices. These findings underscore the importance of RRT timing strategies in critically ill cirrhotic patients.