From the Guidelines
The recommended dose of human albumin for the treatment of hepatorenal syndrome is 1 g/kg body weight (maximum 100 g) on day 1, followed by 20-40 g daily thereafter, administered intravenously in combination with vasoconstrictors. This approach is based on the most recent and highest quality evidence from the 2024 study published in Hepatology 1, which provides guidance on the management of critically ill patients with cirrhosis, including those with hepatorenal syndrome. The use of albumin in this context is aimed at expanding plasma volume, improving cardiac function, and reducing systemic inflammation, thereby working synergistically with vasoconstrictors to improve effective arterial blood volume and renal perfusion. Key points to consider in the administration of albumin for hepatorenal syndrome include:
- Initial dose: 1 g/kg body weight (maximum 100 g) on day 1
- Subsequent dose: 20-40 g daily thereafter
- Administration: Intravenous, in combination with vasoconstrictors such as terlipressin, norepinephrine, or midodrine plus octreotide
- Monitoring: Regular assessment of cardiovascular status, serum albumin levels, renal function parameters, and hemodynamic status to adjust therapy as needed, as suggested by studies such as those published in Gastroenterology 1. It is crucial to monitor the patient's response to therapy and adjust the treatment plan accordingly to minimize the risk of complications, such as fluid overload, particularly in patients with cardiac dysfunction.
From the Research
Albumin Dose for Hepatorenal Syndrome
The recommended dose of albumin for the treatment of hepatorenal syndrome varies across studies.
- A study published in Gastroenterology in 2008 2 used an albumin dose of 1 g/kg followed by 20-40 g/day.
- A study published in The American journal of gastroenterology in 2005 3 administered albumin to increase and/or maintain central venous pressure (CVP) above 3 cm H(2)O, with the need for albumin varying from patient to patient (extremes 40-600 g).
- A study published in European journal of gastroenterology & hepatology in 2021 4 used a standardized approach with albumin, midodrine, and octreotide, with the amount of albumin used being statistically lower in the poststandardization group (425 vs. 332 g, P = 0.05).
- A review published in The Medical clinics of North America in 2023 5 mentions that intravenous albumin is used in combination with vasoconstrictor agents for the treatment of HRS, but does not specify a particular dose.
- A study published in Journal of clinical gastroenterology in 2009 6 used a combination treatment with octreotide, midodrine, and albumin, but does not specify the exact dose of albumin used.
Key Findings
- The use of albumin in combination with other medications, such as terlipressin, midodrine, and octreotide, has been shown to improve renal function and survival in patients with hepatorenal syndrome 2, 4, 6.
- The dose of albumin used can vary depending on the patient's specific needs and the treatment protocol being used 3, 4.
- Standardized treatment regimens that include albumin may lead to improved treatment response rates and reduced rates of renal replacement therapy and liver transplantation 4.