Both renal replacement and extracorporeal albumin/cell based treatment can be used for support in liver failure. In patients with chronic liver disease support therapy is only a bridge to liver transplant.

In patients with acute liver failure/acute-on-chronic liver failure (ALF/ACLF) continuous renal replacement therapy (CRRT) has a role in controlling ammonia levels and intracranial pressure, maintaining cerebral perfusion and oxygenation.

In patients with ALF/ACLF there seems to be an emerging role for CRRT even in patients with normal renal function. Coagulopathy in liver disease is a complex issue; in spite of deranged PT circuit clotting is troubling, cautious use of citrate or thromboelastography based approach to heparin can be considered.