From the Guidelines
When albumin is low, treatment should focus on addressing the underlying cause while supporting nutritional status, with the most recent guidelines from 2024 suggesting the use of intravenous albumin in specific patient populations, such as those with cirrhosis undergoing large-volume paracentesis or with spontaneous bacterial peritonitis 1.
Key Considerations
- Increase protein intake through diet by consuming foods like eggs, meat, fish, dairy, and legumes, aiming for 1-1.5 g of protein per kg of body weight daily.
- In severe cases (albumin below 2.5 g/dL), intravenous albumin infusions may be necessary, typically given as 25% albumin solution at 50-100 mL doses.
- Treat underlying conditions such as liver disease, kidney problems, or malnutrition that may be causing low albumin.
- Monitor fluid balance carefully, as low albumin can lead to edema due to decreased oncotic pressure in blood vessels.
- Supplement with vitamins and minerals, particularly vitamin D, zinc, and B vitamins, which support protein metabolism.
Specific Patient Populations
- For patients with cirrhosis, the use of albumin is recommended for large-volume paracentesis, spontaneous bacterial peritonitis, and hepatorenal syndrome, as per the American Association for the Study of Liver Diseases guidelines from 2021 1.
- In patients with inflammatory bowel disease, hypoalbuminemia is associated with a higher risk of postoperative intra-abdominal sepsis, and treatment should focus on controlling inflammation and treating underlying sepsis, with nutritional support as an important supportive measure 1.
Ongoing Research
- Several ongoing clinical trials are investigating the use of intravenous albumin in different patient populations, including those with community-acquired pneumonia, septic shock, and acute kidney injury, with results expected to provide further guidance on the optimal use of albumin in these settings 1.
From the Research
Causes of Low Albumin
- Hypoalbuminemia can be associated with several different diseases, including cirrhosis, malnutrition, nephrotic syndrome, and sepsis 2
- Inflammation and inadequate protein and caloric intake can reduce albumin concentration in patients with chronic disease such as chronic renal failure 3
- Advanced cirrhosis is characterized by reduced albumin concentration as well as impaired albumin function due to specific structural changes and oxidative damage 4
- The nephrotic syndrome is characterized by increased urinary excretion of albumin and other serum proteins, accompanied by hypoproteinemia and edema formation 5
- Hypoalbuminemia is associated with inflammation, which increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin 6
Management of Low Albumin
- Albumin supplementation should be limited to well-defined clinical scenarios, such as patients with cirrhosis and spontaneous bacterial peritonitis, patients with cirrhosis undergoing large volume paracentesis, and the treatment of type 1 hepatorenal syndrome 2
- Management of hypoalbuminemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin 6
- Nutrition support cannot fully prevent, but slows down, the chain of events associated with decreasing serum albumin levels, especially when combined with physical exercise 6
- The use of angiotensin-converting enzyme inhibitors may blunt the increased albuminuria caused by dietary protein supplementation and allow albumin stores to be increased 5
- Simply administering albumin to critically ill patients with hypoalbuminemia has not been shown to improve survival or reduce morbidity 3