Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

Findik, Orhan; Aydın, Ufuk; Barış, Özgür; Parlar, Hakan; Alagoz, Gokcen Atilboz; Ata, Yusuf; Türk, Tamer; Kunt, Atike Tekeli

doi:10.1532/hsf.1577

Cited by 24 publications

(15 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the antioxidant properties of albumin 154 make it an attractive option for use in cardiac surgery settings, although no RCTs have shown improved outcomes directly due to the oxygen radical scavenging properties of albumin. Hypoalbuminemia has been associated with AKI and need for RRT in the cardiac surgery population [155][156][157][158] . In patients with hypoalbuminemia undergoing off-pump coronary artery bypass graft procedures, preoperative treatment with 20% HSA solution reduced the incidence of postoperative AKI versus treatment with saline alone, but this study does not establish that albumin prevents lipid peroxidation of oxygen free radicals, nor rule out that an increased chloride load with saline alone may have led to hyperchloremic acidosis and decreased renal blood flow 159 .…”

Section: Human Albumin Solution For Renal Protectionmentioning

confidence: 99%

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Wiedermann¹

2020

Current Medical Research and Opinion

View full text Add to dashboard Cite

Objective: Positive fluid balance is common among critically ill patients and leads to worse outcomes, particularly in sepsis, acute respiratory distress syndrome, and acute kidney injury. Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload. Use of human albumin solutions has been investigated in different phases of restrictive fluid resuscitation, and this narrative literature review was undertaken to evaluate hypoalbuminemia and the roles of human serum albumin with respect to hypovolemia and its management.

show abstract

Section: Human Albumin Solution For Renal Protectionmentioning

confidence: 99%

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Wiedermann¹

2020

Current Medical Research and Opinion

View full text Add to dashboard Cite

show abstract

“…Findik et al[15] recently performed a retrospective review of data collected prospectively from 530 adults with normal renal function who underwent isolated CAB surgery. Their analysis divided the patient population based on preoperative serum albumin level and found that RRT ( P = 0.018) and death within 30 d (6.8% vs 2.4%; P = 0.037) after surgery were more frequent in the group with albumin < 3.5 g/dL.…”

Section: Cardiac Surgery and Acute Coronary Interventionsmentioning

confidence: 99%

Causal relationship between hypoalbuminemia and acute kidney injury

Wiedermann¹,

Wiedermann²,

Joannidis³

2017

WJN

View full text Add to dashboard Cite

Our meta-analysis published in 2010 provided evidence that low levels of serum albumin (hypoalbuminemia) are a significant independent predictor of acute kidney injury (AKI) and death following AKI. Since then, a large volume of additional data from observational clinical studies has been published further evaluating the relationship between serum albumin and AKI occurrence. This is an updated review of the literature to re-evaluate the hypothesis that hypoalbuminemia is independently associated with increased AKI risk. Eligible studies published from September 2009 to December 2016 were sought in PubMed (MEDLINE) and forty-three were retained, the great majority being retrospective observational cohort studies. These included a total of about 68000 subjects across a diverse range of settings, predominantly cardiac surgery and acute coronary interventions, infectious diseases, transplant surgery, and cancer. Appraisal of this latest data set served to conclusively corroborate and confirm our earlier hypothesis that lower serum albumin is an independent predictor both of AKI and death after AKI, across a range of clinical scenarios. The body of evidence indicates that hypoalbuminemia may causally contribute to development of AKI. Furthermore, administration of human albumin solution has the potential to prevent AKI; a randomized, controlled study provides evidence that correcting hypoalbuminemia may be renal-protective. Therefore, measurement of serum albumin to diagnose hypoalbuminemia may help identify high-risk patients who may benefit from treatment with exogenous human albumin. Multi-center, prospective, randomized, interventional studies are warranted, along with basic research to define the mechanisms through which albumin affords nephroprotection.

show abstract

“…Cumulative evidence have shown that hypoalbuminemia is an important risk factor for postoperative AKI in various clinical settings [8][9][10][11][12]. However, in surgical settings, studies were mainly focused on cardiac surgery and transplant surgery [11,12,[21][22][23]. Few studies have examined the effect of preoperative hypoalbuminemia on postoperative AKI patients undergoing non-cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study

Qiao

Guo

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) is a common complication following non-cardiac surgery with adverse short- and long- term morbidity and mortality. Evidence shows that hypoalbuminemia is associated with increased AKI risk in patients with infectious diseases and cancer and following cardiac surgery and transplant surgery. However, little evidence is available on non-cardiac surgery population. Thus, we investigated the association between preoperative hypoalbuminemia and AKI following non-cardiac surgery. Methods: We retrospectively assessed perioperative risk factors and preoperative serum albumin concentration in 729 consecutive adult patients who underwent non-cardiac surgery from July 1, 2017, to June 30, 2018. Each patient was categorized according to maximal Kidney Disease Improving Global Outcomes criteria based on creatinine changes and urine output within the first week after surgery. Multivariate Logistic regression models were used to analyze the association between preoperative hypoalbuminemia and postoperative AKI. Results: Of 729 patients, 188 (25.8%) developed AKI. AKI incidence was higher in patients with preoperative serum albumin <37.5 g/L than in those with preoperative serum albumin ≥37.5 g/L [35.9% (98/273) vs. 19.7% (90/456), P<0.001]. Multivariate logistic regression analysis showed that preoperative serum albumin <37.5 g/L (odds ratio 1.892; 95% confidence interval 1.238-2.891; P=0.003) was independently associated with postoperative AKI. Patients with preoperative serum albumin <37.5 g/L tended to have a higher but not significant ratio in AKI stage 2 (2.6% vs 1.1%, P=0.144) and much higher ratio in AKI stage 3 (4.8% vs 0.7%, P<0.001) than those with preoperative serum albumin ≥37.5 g/L. AKI patients had a higher in-hospital mortality rate [6.9% (13/188) vs. 0.2% (1/541), P<0.001]. Kaplan-Meier analysis revealed that the cumulative survival rate decreased with increasing AKI severity (P<0.001). Postoperative AKI was also associated with other worse outcomes, such as prolonged mechanical ventilation [53.4 (33.0, 73.8) vs 14.7 (11.1, 18.3) hours, P<0.001], intensive care unit stay [4.0 (3.1, 4.9) vs 2.0 (1.8, 2.3) days, P<0.001], postoperative hospital stay [17.8 (14.8, 20.9) vs 12.3 (11.3, 13.3) days, P<0.001], and higher total cost [13,453 (8,538, 20,228) vs 11,306 (6,277, 16,400) dollars, P<0.001]. Conclusions Preoperative hypoalbuminemia was independently associated with AKI after non-cardiac surgery, and postoperative AKI was associated with poor outcomes.

show abstract

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

Abstract: Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

Cited by 24 publications

References 32 publications

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Causal relationship between hypoalbuminemia and acute kidney injury

Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study

Contact Info

Product

Resources

About