Intermittent ADVOS vs. Hemodialysis in Non-intensive Care Patients With Liver Dysfunction

Inclusion Criteria: * Capacity of the patient to give consent * Pre-existing liver disease in the sense of an ACLF with HRS * Age \>18 years * Patient of the University Medical Center Mainz * Bilirubin level ≥ 4 mg/dl * Indication for renal replacement procedure is based on STARRT-AKI criteria (serum potassium ≥ 6 mmol/l in two independent blood samples; serum pH of 7.2 or less or serum bicarbonate of 12 mmol/l or less; respiratory failure secondary to volume excess) Exclusion Criteria: * Age \< 18 years * Pregnancy * Contraindications for ADVOS therapy * Already started renal replacement therapy * Contraindication for citrate anticoagulation * Use of vasopressors and MAD ≤ 50 mmHg. * Terminal cancer