Drug Insight: the role of albumin in the management of chronic liver disease

Wong, Florence

doi:10.1038/ncpgasthep0680

Cited by 69 publications

(37 citation statements)

References 65 publications

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“…Albumin appears to circulate from the intravascular to extravascular spaces, and the transcapillary escape rate is determined by the capillary and interstitial free albumin concentrations, microvascular permeability to albumin, movement of solvents and solutes, and transcapillary electrical charge. In patients with hypoalbuminemia (especially when associated with inflammation or sepsis), whose capillaries are known to be hyper-permeable, leakage of albumin into the interstitial space draws water and produces edema [6]. …”

Section: Physiologic Functions Of Albuminmentioning

confidence: 99%

Albumin for End-Stage Liver Disease

Lee

2012

Korean J Intern Med

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Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. While some of these indications are supported by the results of randomized studies, others are based only on clinical experience and have not been proved in prospective studies. The paucity of well-designed trials, the high cost of albumin, the lack of a clear-cut survival benefit, and fear of transmitting unknown infections make the use of albumin controversial. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect. Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration.

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Section: Physiologic Functions Of Albuminmentioning

confidence: 99%

Albumin for End-Stage Liver Disease

Lee

2012

Korean J Intern Med

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“…Firstly, the synthesis of albumin in hepatocytes is reduced, partly related to liver dysfunction, and partly related to the presence of systemic inflammation, which is inherent in the decompensated state [26,27]. Furthermore, the presence of various inflammatory cytokines, especially in those with infection, will increase the rate of albumin catabolism [23]. Therefore, hypoalbuminemia is not uncommon in patients with decompensated cirrhosis.…”

Section: Albuminmentioning

confidence: 97%

“…It is a negatively charged molecule and therefore it attracts sodium and this in turn retains water, thereby providing the oncotic pressure [23]. In addition, albumin has a free cysteine moiety at position 34 (cys-34), which is responsible for the anti-oxidant and scavenging properties of albumin [24].…”

Section: Albuminmentioning

confidence: 99%

Treatment to Improve Acute Kidney Injury in Cirrhosis

Wong

2015

Curr Treat Options Gastro

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Acute kidney injury (AKI) is an ominous complication of decompensated cirrhosis, which can be fatal if not treated promptly. It is important that clinicians recognize that AKI has occurred and institute timely treatment. Recent establishment of diagnostic criteria and treatment guidelines are most useful, and these will be further refined as treatments are being modified to improve patient outcome. To manage such a patient, firstly, the cause of the AKI needs to be identified and any precipitating factors corrected. Bacterial infections are a common cause of AKI in cirrhosis, and it is recommended to offer empirical antibiotics in cases of suspicious bacterial infection until all the cultures are negative. Patients should be given albumin infusion in doses of 1 g/kg of body weight for at least 2 days. This can improve the filling of the central circulation, and also absorb many of the bacterial products or inflammatory cytokines that play a role in mediating the renal dysfunction. Often, albumin infusion alone may be sufficient to reverse the AKI. For patients who have acute or type 1 hepatorenal syndrome (HRS1), which is a special form of AKI, pharmacotherapy in the form of vasoconstrictor will be needed. The vasoconstrictor can be terlipressin, norepinephrine, or midodrine, depending on the local availability of drugs or facilities. Currently, approximately 40 % of patients will respond to a combination of vasoconstrictor and albumin. All patients with HRS1 should be assessed for liver transplant. If accepted for liver transplantation, those patients who do not respond to vasocontrictors and albumin need to be started on renal replacement therapy, which otherwise has no place in the treatment of HRS1. Once listed, liver transplantation should occur promptly, preferable under 2 weeks. Otherwise, the chances for renal recovery after liver transplant are significantly reduced, necessitating a renal transplant at the future date.

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“…As such, SPAD is simple and can be performed by any institution with an established protocol-driven CRRT program. In addition, SPAD requires less technical support/infrastructure than is needed for MARS or Prometheus and, if shown to have similar efficacy in randomized trials, could be less costly (a single session of SPAD includes 10 bottles of 100 ml of 25% albumin and costs roughly CAD 1,000 compared with a single session of a MARS circuit, which costs roughly CAD 4,000) [40,41] .…”

Section: Discussionmentioning

confidence: 99%

A Case-Control Study of Single-Pass Albumin Dialysis for Acetaminophen-Induced Acute Liver Failure

et al. 2009

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Background: Extracorporeal support with single-pass albumin dialysis (SPAD) may remove protein-bound toxins in acute liver failure. We evaluated the clinical, physiological and laboratory parameters of SPAD in acetaminophen-induced acute liver failure (AALF). Methods: Retrospective case-control studies of AALF patients were used. Results: We identified 13 AALF patients (6 SPAD-treated, 7 controls). The average age was 38 years, 92% were female, none had cirrhosis and the Model for End-Stage Liver Disease (MELD) scores were 43. Eleven patients (85%) fulfilled the King’s College criteria for a liver transplant. SPAD-treated patients received 21 sessions (total: 147 h, mean 3.5 runs or 24.5 h/patient). There were no complications. No significant changes in clinical, physiological or biochemical parameters occurred during SPAD. Compared with the controls, there were no significant differences in ICU or 1-year survival, liver recovery or referral for a liver transplant. Conclusion: SPAD was well-tolerated in AALF; however, it was not associated with differences in clinical outcomes. While SPAD may be an adjuvant supportive therapy in AALF, prospective trials are needed.

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Drug Insight: the role of albumin in the management of chronic liver disease

Cited by 69 publications

References 65 publications

Albumin for End-Stage Liver Disease

Albumin for End-Stage Liver Disease

Treatment to Improve Acute Kidney Injury in Cirrhosis

A Case-Control Study of Single-Pass Albumin Dialysis for Acetaminophen-Induced Acute Liver Failure

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