From the Guidelines
Albumin is indicated in patients with impaired renal function for specific clinical scenarios, including spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, and large-volume paracentesis, as it has been shown to reduce the risk of acute kidney injury (AKI) and mortality in these settings. The use of albumin in patients with SBP is supported by multiple randomized controlled trials (RCTs) and meta-analyses, which have demonstrated a significant reduction in the risk of AKI and mortality with albumin administration 1. In patients with SBP, albumin should be administered at a dose of 1.5 g/kg on day 1 and 1 g/kg on day 3, as this has been shown to be effective in preventing AKI and reducing mortality 1.
Some key points to consider when using albumin in patients with impaired renal function include:
- Albumin should not be used in patients with cirrhosis and uncomplicated ascites, as it has not been shown to provide any benefit in this setting 1
- The use of albumin in patients with hepatorenal syndrome is recommended, as it has been shown to improve renal perfusion and reduce the risk of AKI when used in combination with vasoconstrictors like terlipressin or norepinephrine 1
- Close monitoring of fluid status, electrolytes, and renal function is essential during albumin administration, as albumin can cause fluid overload and other adverse effects 1
- The optimal dose and duration of albumin administration in patients with impaired renal function is not well established and should be individualized based on the patient's clinical condition and response to treatment 1.
Overall, the use of albumin in patients with impaired renal function should be reserved for specific clinical scenarios where it has been shown to provide a benefit, and should be used with caution and close monitoring due to the potential for adverse effects.
From the Research
Indications for Albumin Use in Renal Patients
The use of albumin in patients with impaired renal function is a topic of ongoing debate. According to 2, albumin supplementation should be limited to well-defined clinical scenarios, including patients with cirrhosis and spontaneous bacterial peritonitis, patients with cirrhosis undergoing large volume paracentesis, the treatment of type 1 hepatorenal syndrome, fluid resuscitation of patients with sepsis, and therapeutic plasmapheresis with exchange of large volumes of plasma.
Nephrotic Syndrome
In patients with nephrotic syndrome, albumin losses into the urine and across the peritoneal membrane contribute significantly to hypoalbuminemia 3. Co-administration of albumin and furosemide may increase urine volume and sodium levels, which is due to an increase in the glomerular filtration rate (GFR) as well as the diuretic effects of furosemide 4. However, the current evidence is not sufficient to make definitive conclusions about the role of albumin in treating nephrotic edema 5.
Key Points
- Albumin supplementation should be limited to well-defined clinical scenarios 2
- Co-administration of albumin and furosemide may increase urine volume and sodium levels in patients with nephrotic syndrome 4
- The current evidence is not sufficient to make definitive conclusions about the role of albumin in treating nephrotic edema 5
- Albumin losses into the urine and across the peritoneal membrane contribute significantly to hypoalbuminemia in patients with nephrotic syndrome 3
Clinical Scenarios
Some clinical scenarios where albumin may be indicated in renal patients include:
- Nephrotic syndrome with severe edema
- Hepatorenal syndrome
- Therapeutic plasmapheresis with exchange of large volumes of plasma
- Fluid resuscitation of patients with sepsis Note that these indications are based on the available evidence and may not be universally accepted.