Evidence map›Paper›PMID 42332991›Full record

Trial reportAlimentary pharmacology & therapeutics2026

Pre-Emptive Initiation of Continuous Renal Replacement Therapy in Patients With Acute Liver Failure With Cerebral Edema Improves Outcomes: A Randomized Controlled Trial.

Rakhi Maiwall, Meenu Bajpai, Samba Siva Rao Pasupuleti, Neha Chauhan, Mohit Prajapati, Manya Prasad, Prashant Agarwal, Rajendra Prasad Mathur, Sherin Thomas, Shiv Kumar Sarin

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Alimentary pharmacology & therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04991259 (To Evaluate the Safety and Efficacy of Preemptive Administration of Continuous Renal Replacement Therapy in Patients With Acute Liver Failure With Cerebral Edema -A Prospective Randomized Controlled Trial), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04991259 naunknown statusnot on this map

To Evaluate the Safety and Efficacy of Preemptive Administration of Continuous Renal Replacement Therapy in Patients With Acute Liver Failure With Cerebral Edema -A Prospective Randomized Controlled Trial

TypeinterventionalSponsorInstitute of Liver and Biliary Sciences, IndiaRan2021 to 2023Enrolled60ConditionsAcute Liver FailureArmsContinuous Renal Replacement Therapy (CRRT), Standard Medical Treatment
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Rakhi MaiwallDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Meenu BajpaiDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Samba Siva Rao PasupuletiDepartment of Statistics, Department of Applied Mathematics and Statistics, Pachhunga University College, Mizoram University (A Central University), Aizawl, India.
Neha ChauhanDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Mohit PrajapatiDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Manya PrasadDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Prashant AgarwalDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Rajendra Prasad MathurDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Sherin ThomasDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Shiv Kumar SarinDepartment of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.ORCID https://orcid.org/0000-0002-0544-5610

Funding

Indian Council of Medical Research 09/7882/SGP-2023
6 · The paper itself

Abstract

BACKGROUND AND

aimAn early initiation of continuous renal replacement therapy (CRRT) for ammonia reduction has shown a reduction in deaths due to cerebral edema (CE) in acute liver failure (ALF); however, there are no controlled trials assessing the same.

methodsWe performed an open-label pilot randomized controlled trial (RCT) on ALF patients with CE. Patients underwent therapeutic plasma-exchange (PLEX) by centrifugal apheresis after initial resuscitation. Group 1 received CRRT initiation within the first 12 h, while Group 2, CRRT was initiated for PLEX non-responders. The primary endpoint was 28-day survival.

resultsPatients aged 28.11 ± 10.10 years, 56.67% viral, 69% hyperacute were randomized. At day 28, 46% died and 11% underwent liver transplant. There were a total of 31 protocol violations, significantly more in group 2 (55.6% vs. 13.3%; p < 0.001). On ITT and piece-wise exponential regression analysis, pre-emptive CRRT was associated with a significantly lower hazard of death during the first 7 days (2.2% vs. 17.8% Hazard ratio [HR] 0.12, 95% confidence interval [CI] 0.02-0.96) with comparable survival at 28-days. Notably, higher 28-day mortality was observed on PP analysis in group 2 (80% vs. 46%, HR 3.10, 95% CI 1.57-6.12) with a significantly higher reduction in ammonia and improvement in mean arterial pressure and lower number of sessions of TPE. Each hour delay in CRRT was associated with increased mortality (HR 1.01, 1.00-1.02).

conclusionA pre-emptive initiation of CRRT in ALF patients is synergistic to TPE, reduces early deaths by rapid improvement in hemodynamics, ammonia and cerebral edema (NCT04991259).

Indexed as

Brain EdemaContinuous Renal Replacement TherapyLiver Failure, AcuteAdultAmmoniaFemaleHumansMaleMiddle AgedPilot ProjectsPlasma ExchangeTreatment OutcomeYoung AdultAmmoniaAKIammoniaCKRTCRRTlactateoXirisplasma‐exchangesepsis

Identifiers

PMID42332991
PMCPMC13511368

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Registered trials

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