Inclusion Criteria:  - Patients with acute liver failure defined patients with jaundice which is complicated by encephalopathy and coagulopathy within 4 weeks of the onset of jaundice and without underlying chronic liver disease with documented cerebral edema on CT-scan and arterial ammonia >150 ug/dL.  Exclusion Criteria:  Age <18 or > 70 years Hepatocellular Carcinoma Active untreated Sepsis/DIC Hemodynamic instability requiring high dose of vasopressors Post-resection and malignancy related liver failure Coma of non-hepatic origin Patients with post renal obstructive AKI, AKI suspected due to glomerulonephritis, interstitial nephritis or vasculitis based on clinical history and urine analysis Patients already meeting emergency criteria for immediate initiation of dialysis at the time of randomization (serum potassium>6 meq/lt, metabolic acidosis ph<7.12, acute pulmonary edema, severe volume overload with hypoxemia non-responsive to diuretic treatment) Patients transferred from other hospitals who have already been on hemodialysis before their arrival in the intensive care unit Extremely moribund patients with an expected life expectancy of less than 24 hours Pregnancy related liver failure Patients with significant renal dysfunction meeting absolute criteria for initiation of dialysis Comorbidities associated with poor outcome (Extrahepatic neoplasia, severe cardiopulmonary disease defined by a New York Heart Association score >3, or oxygen/steroid-dependent chronic obstructive pulmonary disease) Patients being taken up for liver transplant Refusal to participate in the study.