Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy
Rupesh Raina, Jirair K. Bedoyan, Uta Lichter‐Konecki, Philippe Jouvet, Stefano Picca, Nicholas Ah Mew, Marcel Cerqueira César Machado, Ronith Chakraborty, Meghana Vemuganti, Manpreet Kaur Grewal, Timothy E. Bunchman, Sidharth Kumar Sethi, Vinod Krishnappa, Mignon McCulloch, Khalid Alhasan, Arvind Bagga, Rajit K. Basu, Franz Schaefer, Guido Filler, Bradley A. Warady
Abstract
Hyperammonaemia in children can lead to grave consequences in the form of cerebral oedema, severe neurological impairment and even death. In infants and children, common causes of hyperammonaemia include urea cycle disorders or organic acidaemias. Few studies have assessed the role of extracorporeal therapies in the management of hyperammonaemia in neonates and children. Moreover, consensus guidelines are lacking for the use of non-kidney replacement therapy (NKRT) and kidney replacement therapies (KRTs, including peritoneal dialysis, continuous KRT, haemodialysis and hybrid therapy) to manage hyperammonaemia in neonates and children. Prompt treatment with KRT and/or NKRT, the choice of which depends on the ammonia concentrations and presenting symptoms of the patient, is crucial. This expert Consensus Statement presents recommendations for the management of hyperammonaemia requiring KRT in paediatric populations. Additional studies are required to strengthen these recommendations.