From the Guidelines
Albumin can help reduce peripheral edema in specific clinical situations, such as cirrhosis and nephrotic syndrome, by increasing oncotic pressure within blood vessels.
Key Points to Consider
- The use of albumin in reducing peripheral edema is most effective in conditions where there is a significant loss of albumin or a need to rapidly expand plasma volume, such as in cirrhosis with spontaneous bacterial peritonitis (SBP) or hepatorenal syndrome (HRS) 1.
- Typical dosing of albumin for edema ranges from 25 to 100 grams (as 5% or 25% solutions) administered intravenously, with the specific amount determined by the patient's condition and response 1.
- Albumin is not a first-line treatment for most types of edema; diuretics like furosemide are typically used initially, and albumin may be considered in specific cases where diuretics are not effective or in conditions like SBP where it has been shown to reduce the risk of renal failure and death 1.
- The mechanism of action of albumin involves increasing oncotic pressure within blood vessels, which helps draw excess fluid from tissues back into the circulation, thus reducing edema 1.
- However, albumin carries risks including allergic reactions, fluid overload, and transmission of infection, and its use should be carefully considered based on the patient's clinical condition and the potential benefits and risks 1.
Clinical Evidence
- A recent study published in Gastroenterology found that albumin administration in patients with SBP significantly reduced the risk of AKI and death compared to those who received antibiotics alone 1.
- Another study published in Hepatology found that albumin treatment in patients with decompensated cirrhosis reduced systemic inflammation and circulatory dysfunction, but noted that the broader use of albumin as a resuscitation agent in critically ill patients with cirrhosis is not well defined 1.
- The use of albumin in patients with cirrhosis and uncomplicated ascites is not recommended, as standard therapy with sodium restriction and diuretics is typically effective, and albumin has not been shown to improve outcomes in this population 1.
From the Research
Albumin and Peripheral Edema
- Albumin has been used to treat peripheral edema in patients with nephrotic syndrome and cirrhosis, with some studies suggesting it may provide clinical benefits for select patients 2.
- The use of human albumin for the treatment of ascites in patients with liver cirrhosis has been found to be effective in preventing circulatory dysfunctions after large-volume paracentesis and renal failure, and after Spontaneous Bacterial Peritonitis (SBP) 3.
- Human albumin infusion has been used to treat oedema in people with nephrotic syndrome, but the quantitative contribution of human albumin in treating oedema is not fully understood, and more research is needed to determine its effectiveness 4.
Mechanism of Action
- Albumin acts as a plasma volume expander, increasing circulating blood volume and inducing diuresis 3, 5.
- Albumin also has non-oncotic properties, including antioxidant, radical scavenger, and immune modulator effects, which may contribute to its therapeutic benefits 5.
Clinical Evidence
- A study in nephrotic children found that albumin and furosemide therapy increased plasma volume transiently, with a decrease in body weight, abdominal circumference, and edema 6.
- Another study found that long-term albumin therapy in patients with cirrhosis and ascites improved survival, prevented complications, simplified ascites management, and lowered hospitalization rates 5.
- However, the evidence is not consistent, and more research is needed to fully understand the role of albumin in treating peripheral edema 2, 4.