From the Guidelines
The recommended albumin infusion rate is 1.5 g/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3, in patients with SBP and an increased serum creatinine or a rising serum creatinine, as recommended by the most recent and highest quality study 1.
Key Considerations
- The infusion rate should be carefully controlled to avoid fluid overload, pulmonary edema, or heart failure, particularly in patients with compromised cardiovascular function.
- Patient-specific factors, including cardiac function, fluid status, and the indication for albumin therapy, should guide the infusion rate.
- The oncotic properties of albumin draw fluid into the vascular space, so monitoring vital signs, urine output, and respiratory status during administration is essential to detect any adverse effects early.
Clinical Context
- In patients with cirrhosis and ascites, albumin infusion may be considered after paracentesis of >5 L at a dose of 8 g albumin/L of ascites removed, as recommended by guidelines 2, 3.
- In patients with ACLF or high risk of post-paracentesis acute kidney injury, albumin infusion may be considered after paracentesis of <5 L at a dose of 8 g albumin/L of ascites removed, although the quality of evidence is low 2, 3.
- The use of albumin in patients with SBP has been shown to reduce the risk of renal dysfunction and mortality, with a recommended dose of 1.5 g/kg on day 1 and 1 g/kg on day 3 4, 1.
From the FDA Drug Label
Since hypoproteinemic patients usually have approximately normal blood volumes, the rate of administration of Plasbumin-25 should not exceed 2 mL per minute, as more rapid injection may precipitate circulatory embarrassment and pulmonary edema. The recommended albumin (human albumin) infusion rate is not to exceed 2 mL per minute 5.
From the Research
Albumin Infusion Rate
The recommended albumin infusion rate is not explicitly stated in the provided studies. However, the following information can be gathered:
- A study published in 2024 6 compared the effects of rapid and slow infusion rates of 5% albumin in postoperative patients after major surgery. The results showed that the change in plasma volume from the start of infusion to 180 min did not differ between the slow and rapid infusion groups.
- The study 6 used infusion rates of 10 ml/kg (ideal body weight) either rapidly (30 min) or slowly (180 min).
- Another study published in 2023 7 investigated the association between daily albumin infusion and 28-day mortality in septic patients with liver cirrhosis. Although the study does not provide information on the infusion rate, it suggests that albumin infusion is associated with a reduced risk of 28-day death under specific circumstances.
Key Findings
- The optimal infusion rate of colloids in patients with suspected hypovolemia is unknown 6.
- Plasma volume expansion by 5% albumin is not greater if fluid is administered slowly rather than rapidly 6.
- The use of albumin in critically ill patients with cirrhosis and AKI should be approached with greater consideration of its risks and benefits 8.
Considerations for Albumin Infusion
- Serum albumin concentration, serum lactate concentration, mean arterial pressure (MAP), and vasopressor dosage should be considered when deciding to initiate albumin infusion 7.
- Albumin infusion may be beneficial in patients with cirrhosis and AKI, but its efficacy depends on various factors, including the concentration of albumin used and the patient's baseline characteristics 8.