Management of L-Ornithine L-Aspartate in Acute Kidney Injury

Introduction to LOLA Use in AKI

• The Critical Care Medicine guidelines state that there is insufficient evidence to support the use of L-Ornithine L-Aspartate (LOLA) in critically ill patients with acute liver failure (ALF) and hyperammonemia, including those with acute kidney injury (AKI) 1

Nephrotoxic Medication Management in AKI

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines do not specifically address LOLA use in AKI patients, but recommend that patients with AKI receive potentially nephrotoxic medications only if needed and only for as long as needed 4
• The Kidney International guidelines suggest that kidney function must be monitored in patients who are exposed to agents that could affect kidney function or cause injury, and that the risk-benefit ratio for medication use in AKI must be carefully considered and therapy personalized according to individual patient risks 4, 5

Rationale for Avoiding LOLA in AKI

• The Nature Reviews Nephrology guidelines state that AKI represents a state of altered drug metabolism and clearance that can lead to unpredictable pharmacokinetics, and that organ crosstalk, particularly involving the liver and kidney, can influence drug metabolism during AKI 5

Management Considerations for Medications in AKI

• The Kidney International guidelines recommend that drug stewardship is critical in AKI, with the primary goal of balancing the changing risks and benefits of drug utilization and dosing, and that certain drug combinations and overall drug burden are associated with worsening AKI 4
• The Nature Reviews Nephrology guidelines suggest that if medication is absolutely necessary in AKI patients, regular monitoring of functional status is needed, and that duration and dose of any potentially nephrotoxic agent should be minimized 5

Alternatives and Monitoring

• The Nature Reviews Nephrology guidelines recommend that evidence-based dosing guidelines should be followed when medications must be used in AKI patients 5

Clinical Pitfalls to Avoid

• The Kidney International guidelines warn that adding medications without clear evidence of benefit to patients with AKI increases the risk of adverse effects, and that medications that undergo renal elimination should be used with caution due to the risk of harm from accumulation of parent drug or metabolites in AKI 4