The complexity of dialytic therapy in hyperammonemic neonates.

The utilization of renal replacement therapy (RRT) in the setting of hyperammonia is a rare and complicated occurrence. Data demonstrate that the quicker the ammonia level is normalized, the better the neurological outcome. The optimal form of RRT is often decided by local practice. The recent work by Picca and colleagues details a larger series of children who underwent RRT for hyperammonia and adds some credence to the use of peritoneal dialysis (PD) in this population. While these authors conclude that PD is not optimal, they do note that the use of PD may be an option when other forms of RRT are not available. The results reinforce the general maxim that you should continue to do that which you do well and often, which in this context refers to continuing to use your form of RRT until alternative modalities are available.