{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:36:19Z","timestamp":1790613379310,"version":"4.1.0"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:p>Hyperammonemia is an important cause of cerebral edema in both adults with liver failure and children with inborn errors of metabolism. There are few studies that have analyzed the role of extracorporeal dialysis in reducing blood ammonia levels in the adult population. Furthermore, there are no firm guidelines about when to implement RRT, because many of the conditions that are characterized by hyperammonemia are extremely rare. In this review of existing literature on RRT, we present the body\u2019s own mechanisms for clearing ammonia as well as the dialytic properties of ammonia. We review the available literature on the use of continuous venovenous hemofiltration, peritoneal dialysis, and hemodialysis in neonates and adults with conditions characterized by hyperammonemia and discuss some of the controversies that exist over selecting one modality over another.<\/jats:p>","DOI":"10.2215\/cjn.01320216","type":"journal-article","created":{"date-parts":[[2016,5,20]],"date-time":"2016-05-20T05:53:53Z","timestamp":1463723633000},"page":"1872-1878","source":"Crossref","is-referenced-by-count":86,"title":["The Role of RRT in Hyperammonemic Patients"],"prefix":"10.2215","volume":"11","author":[{"given":"Shruti","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Z.","family":"Fenves","sequence":"additional","affiliation":[{"name":"Renal Division, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hootkins","sequence":"additional","affiliation":[{"name":"ESRD Consulting, PLLC, Austin, Texas; and"},{"name":"Department of Medicine, University of Texas Southwestern, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,5,19]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1002\/hep.510290309","article-title":"Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration","volume":"29","author":"Clemmesen","year":"1999","journal-title":"Hepatology"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.mayocp.2015.03.003","article-title":"Refining the ammonia hypothesis: A physiology-driven approach to the treatment of hepatic encephalopathy","volume":"90","author":"Tapper","year":"2015","journal-title":"Mayo Clin Proc"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/liv.12221","article-title":"Ammonia clearance with haemofiltration in adults with liver disease","volume":"34","author":"Slack","year":"2014","journal-title":"Liver Int"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1002\/glia.20003","article-title":"Glutamine-induced free radical production in cultured astrocytes","volume":"46","author":"Jayakumar","year":"2004","journal-title":"Glia"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1159\/000159228","article-title":"Cytochrome P450 metabolites of arachidonic acid as intracellular signaling molecules in vascular tissue","volume":"34","author":"Harder","year":"1997","journal-title":"J Vasc Res"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/cphy.c120010","article-title":"Renal ammonia metabolism and transport","volume":"3","author":"Weiner","year":"2013","journal-title":"Compr Physiol"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00467-011-1838-5","article-title":"Hyperammonemia in review: Pathophysiology, diagnosis, and treatment","volume":"27","author":"Auron","year":"2012","journal-title":"Pediatr Nephrol"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/glia.20624","article-title":"Gene expression profiling of astrocytes from hyperammonemic mice reveals altered pathways for water and potassium homeostasis in vivo","volume":"56","author":"Lichter-Konecki","year":"2008","journal-title":"Glia"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jhep.2011.03.021","article-title":"Threshold for toxicity from hyperammonemia in critically ill children","volume":"56","author":"Ozanne","year":"2012","journal-title":"J Hepatol"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S0002-9343(02)01477-8","article-title":"Correlation between ammonia levels and the severity of hepatic encephalopathy","volume":"114","author":"Ong","year":"2003","journal-title":"Am J Med"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1002\/hep.510310107","article-title":"Partial pressure of ammonia versus ammonia in hepatic encephalopathy","volume":"31","author":"Kramer","year":"2000","journal-title":"Hepatology"},{"key":"B17-20230813","first-page":"66","article-title":"The role of protein metabolism in 204 liver cirrhotics with and without hepatic encephalopathy. 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