Reply to: “Possible link between higher ammonia levels, non-alcoholic fatty liver-related cirrhosis and diabetes: Are we missing chronic kidney disease?”

Thomas H. Tranah; María-Pilar Ballester; Juan Antonio Carbonell-Asins; Rajiv Jalan; Debbie L. Shawcross

doi:10.1016/j.jhep.2022.10.024

Letter to the Editor| Volume 78, ISSUE 2, e73-e74, February 2023

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Reply to: “Possible link between higher ammonia levels, non-alcoholic fatty liver-related cirrhosis and diabetes: Are we missing chronic kidney disease?”

Thomas H. Tranah ^†
Author Footnotes
† Joint first authors,
Thomas H. Tranah
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† Joint first authors,
Affiliations
Institute of Liver Studies, Dept of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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María-Pilar Ballester ^†
Author Footnotes
† Joint first authors,
María-Pilar Ballester
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† Joint first authors,
Affiliations
Digestive Disease Department, Hospital Clínico Universitario de Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
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Juan Antonio Carbonell-Asins ^†
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† Joint first authors,
Juan Antonio Carbonell-Asins
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† Joint first authors,
Affiliations
INCLIVA Biomedical Research Institute, Valencia, Spain
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Rajiv Jalan ^‡
Author Footnotes
‡ Joint senior authors
Rajiv Jalan
Correspondence
Corresponding author. Address: Liver Failure Group, Institute for Liver and Disease Health, University College London, Royal Free Campus. Rowland Hill Street, London, NW3 2PF, United Kingdom; Tel.: +44 02074332795.
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‡ Joint senior authors
Affiliations
Liver Failure Group, Institute for Liver and Digestive Health, University College London, Royal Free Campus, United Kingdom
European Foundation for the Study of Chronic Liver Failure (EF Clif), Spain
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Debbie L. Shawcross ^‡
Author Footnotes
‡ Joint senior authors
Debbie L. Shawcross
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‡ Joint senior authors
Affiliations
Institute of Liver Studies, Dept of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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† Joint first authors,
‡ Joint senior authors

Published:November 01, 2022DOI:https://doi.org/10.1016/j.jhep.2022.10.024

We would like to thank Elfeki et al. for their interest in our recently published article.

^[1]

Tranah T.H.
Ballester M.P.
Carbonell-Asins J.A.
Ampuero J.
Alexandrino G.
Caracostea A.
et al.

Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis.

^,

^[2]

Elfeki M.A.
Singal A.K.

Possible link between higher ammonia levels, non-alcoholic fatty liver-related cirrhosis and diabetes: are we missing chronic kidney disease?.

Our study of 754 patients demonstrated that ammonia was an independent predictor of mortality and when expressed as a ratio of the local laboratory upper limit of normal (AMM-ULN), defines a group at high risk of developing liver-related complications. This was confirmed in an independent validation cohort of 130 stable outpatients with cirrhosis.

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Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis
Journal of HepatologyVol. 77Issue 6
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  Hyperammonaemia is central in the pathogenesis of hepatic encephalopathy. It also has pleiotropic deleterious effects on several organ systems, such as immune function, sarcopenia, energy metabolism and portal hypertension. This study was performed to test the hypothesis that severity of hyperammonaemia is a risk factor for liver-related complications in clinically stable outpatients with cirrhosis.
- Full-Text
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Open Access
Possible link between higher ammonia levels, non-alcoholic fatty liver-related cirrhosis and diabetes: Are we missing chronic kidney disease?
Journal of HepatologyVol. 78Issue 2
- Preview
  We read with interest the study by Tranah and colleagues,¹ recently published in the Journal. This unique multicenter prospective study measured ammonia blood levels in 754 clinically stable outpatients with cirrhosis, to evaluate ammonia as a risk factor for liver related complications. Baseline ammonia levels were corrected to the upper limit of normal (AMM-ULN) for the reference lab. Two hundred and sixty patients (35%) were hospitalized with liver-related complications during follow-up (median follow up 223 days) and AMM-ULN was an independent predictor for both liver-related complications (hazard ratio 2.13; 95% CI 1.89-2.40; p <0.001) and mortality (hazard ratio 1.45; 95% CI 1.20-1.76; p <0.001).
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References

- Tranah T.H.
- Ballester M.P.
- Carbonell-Asins J.A.
- Ampuero J.
- Alexandrino G.
- Caracostea A.
- et al.
Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis.
J Hepatol. 2022 Jul 22; (S0168-8278(22)02947-6)
View in Article
- Elfeki M.A.
- Singal A.K.
Possible link between higher ammonia levels, non-alcoholic fatty liver-related cirrhosis and diabetes: are we missing chronic kidney disease?.
J Hepatol. 2022 Sep 30; (S0168-8278(22)03125-7)
View in Article
- Wang T.-Y.
- Wang R.-F.
- Bu Z.-Y.
- Targher G.
- Byrne C.D.
- Sun D.-Q.
- et al.
Association of metabolic dysfunction-associated fatty liver disease with kidney disease.
Nat Rev Nephrol. 2022; 18: 259-268
View in Article
- Sun D.Q.
- Jin Y.
- Wang T.Y.
- Zheng K.I.
- Rios R.S.
- Zhang H.Y.
- et al.
MAFLD and risk of CKD.
Metabolism. 2021; 115154433
View in Article

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Publication history

Published online: November 01, 2022

Accepted: October 21, 2022

Received: October 19, 2022

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DOI: https://doi.org/10.1016/j.jhep.2022.10.024

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Reply to: “Possible link between higher ammonia levels, non-alcoholic fatty liver-related cirrhosis and diabetes: Are we missing chronic kidney disease?”

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