A patient with fulminant hepatic encephalopathy and acute renal failure progressively deteriorated following daily hemodialysis with a hollow fiber artificial kidney improved dramatically after an initial dialysis with a polyacrylonitrile membrane system. Following repetitive dialysis with this system the patient continued to improve and is well many months following discharge. His course during hemodialysis with membrane systems having different clearances for substances of various molecular weights suggests the hypothesis that a substance(s) with a molecular weight between 1,500 and 15,000 daltons is involved in the pathogenesis of hepatic encephalopathy and offers and additional therapeutic modality for his devastating disease.
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