Abstract
Acute kidney injury occurs in up to 20 % of cirrhotic patients hospitalized with portal hypertension and portosystemic collaterals. Reduction in the effective blood volume leads to pronounced vasoconstriction, involving preferentially renal and central nervous system blood vessels. Acute kidney injury is due to renal hypoperfusion and, accordingly, shows an improvement with volume expansion. The most well-established indications for albumin in cirrhosis are prevention of post-paracentesis circulatory dysfunction during large-volume paracentesis in the treatment of refractory ascites, prevention of hepatorenal syndrome in patients with spontaneous bacterial peritonitis, and hepatorenal syndrome treatment. A strong recommendation can be made for albumin administration in order to prevent acute kidney injury and to reduce mortality in cirrhotic patients with spontaneous bacterial peritonitis. Albumin may also have beneficial effects on a number of other complications in cirrhosis, although further studies are needed before any definitive conclusion can be made.
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References
Angeli P, Gines P, Wong et al (2015) Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut 64:531–537
Egerod Israelsen M, Gluud LL, Krag A (2015) Acute kidney injury and hepatorenal syndrome in cirrhosis. J Gastroenterol Hepatol 30:236–243
Sort P, Navasa M, Arroyo V et al (1999) Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 341:403–409
Wiedermann CJ, Dunzendorfer S, Gaioni LU et al (2010) Hyperoncotic colloids and acute kidney injury: a meta-analysis of randomized trials. Crit Care 14:R191
Ulusoy S, Ari D, Ozkan G et al (2015) The frequency and outcome of acute kidney injury in a tertiary hospital: which factors affect mortality? Artif Organs 39:597–606
Moon KW, Kim J, Kim JH et al (2011) Risk factors for acute kidney injury by non-steroidal anti-inflammatory drugs in patients with hyperuricaemia. Rheumatology (Oxford) 50:2278–2282
Downes KJ, Patil NR, Rao MB et al (2015) Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis. Pediatr Nephrol 30:1879–1888
Murat SN, Kurtul A, Yarlioglues M (2015) Impact of serum albumin levels on contrast-induced acute kidney injury in patients with acute coronary syndromes treated with percutaneous coronary intervention. Angiology 66:732–737
Lee EH, Baek SH, Chin JH et al (2012) Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med 38:1478–1486
Kim WH, Park MH, Kim HJ et al (2015) Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine (Baltimore) 94:e273
Moguel-González B, Wasung-de-Lay M, Tella-Vega P et al (2013) Acute kidney injury in cardiac surgery. Rev Invest Clin 65:467–475
Lee EH, Kim HR, Baek SH et al (2014) Risk factors of postoperative acute kidney injury in patients undergoing esophageal cancer surgery. J Cardiothorac Vasc Anesth 28:936–942
De Oliveira FS, Freitas FG, Ferreira EM et al (2015) Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock. J Crit Care 30:97–101
Acheampong A, Vincent JL (2015) A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care 19:251
Wiedermann CJ, Joannidis M (2015) Nephroprotective potential of human albumin infusion: a narrative review. Gastroenterol Res Pract 2015:91283916
Finfer S, Bellomo R, Boyce N et al (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256
Romanelli RG, La Villa G, Barletta G et al (2006) Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblinded randomized trial. World J Gastroenterol 12:1403–1407
Bari K, Miñano C, Shea M et al (2012) The combination of octreotide and midodrine is not superior to albumin in preventing recurrence of ascites after large-volume paracentesis. Clin Gastroenterol Hepatol 10:1169–1175
Garcia-Martinez R, Caraceni P, Bernardi M et al (2013) Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology 58:1836–1846
Ginès P, Titó L, Arroyo V et al (1988) Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 94:1493–1502
European Association for the Study of the Liver (2010) EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 53:397–417
Runyon BA, AASLD Practice Guidelines Committee (2009) Management of adult patients with ascites due to cirrhosis: an update. Hepatology 49:2087–2107
Bernardi M, Caraceni P, Navickis R et al (2012) Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology 55:1172–1181
Nicholson JP, Wolmarans MR, Park GR (2000) The role of albumin in critical illness. Br J Anaesth 85:599–610
Evans TW (2000) Review article: albumin as a drug—biological effects of albumin unrelated to oncotic pressure. Aliment Pharmacol Ther 16(Suppl 5):6–11
Lenz K, Buder R, Kapun L et al (2015) Treatment and management of ascites and hepatorenal syndrome: an update. Ther Adv Gastroenterol 8:83–100
Alessandria C, Elia C, Mezzabotta L et al (2011) Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: standard vs half albumin doses. A prospective, randomized, unblinded pilot study. Dig Liver Dis 43:881–886
Bernardi M, Ricci CS, Zaccherini G (2014) Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol 4:302–311
Landoni G, Bove T, Székely A et al (2013) Reducing mortality in acute kidney injury patients: systematic review and international web-based survey. J Cardiothorac Vasc Anesth 27(6):1384–1398
Martín-Llahí M, Pepin MN, Guevara M et al (2008) Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 134:1352–1359
Sanyal AJ, Boyer T, Garcia-Tsao G et al (2008) A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology 134:1360–1368
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Wiedermann, C.J. (2016). Albumin to Reduce Mortality in Cirrhotic Patients with Acute Kidney Injury. In: Landoni, G., Pisano, A., Zangrillo, A., Bellomo, R. (eds) Reducing Mortality in Acute Kidney Injury. Springer, Cham. https://doi.org/10.1007/978-3-319-33429-5_16
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DOI: https://doi.org/10.1007/978-3-319-33429-5_16
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