What is the treatment for hypoalbuminemia?

Treatment of Hypoalbuminemia

The primary approach to treating hypoalbuminemia should focus on identifying and treating the underlying cause rather than simply correcting the low albumin level itself, as albumin infusion is not recommended for routine treatment of hypoalbuminemia alone. 1, 2

Understanding Hypoalbuminemia

• Hypoalbuminemia is common in acute and chronic illness and is associated with greater morbidity compared to patients with normal albumin levels 1
• It is a valid and clinically useful measure of protein-energy nutritional status in patients with chronic conditions such as kidney disease 1
• Hypoalbuminemia can result from multiple causes including inflammation, malnutrition, protein loss, liver dysfunction, and dilution with crystalloids 3

Primary Treatment Approach

• Focus on treating the underlying cause of hypoalbuminemia rather than the low albumin level itself 1, 2
• Provide adequate nutritional support, especially in malnourished patients 1, 2
• Regular assessment of serum albumin levels is necessary to monitor for improvement 1

Specific Clinical Scenarios Where Albumin Infusion May Be Considered

Liver Disease

• Albumin infusion is recommended for patients with spontaneous bacterial peritonitis 1, 2
• Albumin infusion is suggested to prevent paracentesis-induced circulatory dysfunction in patients undergoing large-volume paracentesis (>5L) 1, 2, 4
• For patients with hyponatremia and cirrhosis, fluid restriction to 1,000 mL/day is suggested for moderate hyponatremia (120-125 mEq/L) 2

Critical Care

• Albumin may be considered as second-line and adjunctive to crystalloids for fluid resuscitation in specific conditions, such as septic shock 2, 4
• The fluid balance was lower in patients receiving albumin compared to crystalloids in sepsis patients 5

Surgical Patients

• Preoperative hypoalbuminemia (<30 g/L) is associated with higher risk of postoperative intra-abdominal sepsis 1, 2
• Correction of nutritional deficiency is recommended when feasible before cardiac surgery 1

When Albumin Infusion Is Not Recommended

• Not recommended for first-line volume replacement or to increase serum albumin levels in critically ill adult patients (excluding thermal injuries and ARDS) 1, 2
• Not recommended in conjunction with diuretics for removal of extravascular fluid 1
• Not recommended for preterm neonates with respiratory distress and low serum albumin levels 1
• Not recommended for patients undergoing kidney replacement therapy for prevention or treatment of intradialytic hypotension 1
• Not recommended for pediatric patients undergoing cardiovascular surgery 1
• Not recommended for nutritional purposes 4

Monitoring and Prognosis

• Hypoalbuminemia is a strong prognosticator of increased all-cause and cardiovascular mortality 6
• Serum albumin concentration appears to be a good prognostic marker for acute surgical patients 7
• A meta-analysis found that a decrease of 1.0 g/dL in serum albumin increased the odds of morbidity by 89% and of mortality by 137% 5

Cautions

• Simple albumin infusion for patients with hypoalbuminemia did not improve survival in acute surgical patients 7
• Albumin infusion is expensive (approximately $130/25g USD) and has potential adverse effects including fluid overload, hypotension, hemodilution requiring RBC transfusion, anaphylaxis, and peripheral gangrene 1
• In hospitalized patients with decompensated cirrhosis, hyperoncotic albumin to target a level >30 g/L showed no improvement in outcomes compared to no albumin 1

Special Considerations

• In patients with nephrotic syndrome, hypoalbuminemia results from urinary albumin losses, increased fractional catabolic rate, and insufficient increase in albumin synthesis 8
• In CAPD patients, albumin losses into the urine and across the peritoneal membrane contribute significantly to hypoalbuminemia 8
• In hemodialysis patients, hypoalbuminemia results primarily from reduced albumin synthesis due to inflammation and inadequate nutrition 8