The relationship between hypoalbuminemia and intradialytic hypotention in hemodialysis patients

Kora, Mahmoud A; Tawfeek, Ahmed R; Elzorkany, Khaled Mohamed Amin; El-Mohsen, Asmaa H Abd

doi:10.4103/mmj.mmj_108_18

Cited by 1 publication

(2 citation statements)

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“…More broadly, a recent network metanalysis including ten studies (6664 patients) with direct comparison could not establish an increased risk for KRT when comparing albumin with crystalloids with moderate certainty (although this included studies of iso-oncotic albumin) (45). In a trial of patients with severe sepsis ( n =1818), those randomized to 20% albumin plus crystalloid (targeting albumin >30 g/L) were not at increased risk of severe AKI as a predefined secondary outcome (serum creatinine >300 μ mol/L) compared with those randomized to crystalloid alone (21). A post hoc analysis also found no difference between the groups when AKI was defined according to RIFLE criteria.…”

Section: Safety Of Intravenous Albumin Administrationmentioning

confidence: 99%

“…Notably, the correlation between hypoalbuminemia and increased mortality in patients on maintenance HD is markedly less in those with normal C-reactive protein levels (19). Similarly, hypoalbuminemia is independently associated with IDH (20,21), theoretically due to its effect on oncotic pressure in the circulation; however, residual confounding on the basis of concurrent chronic or severe illness is very likely.…”

Section: Incidence and Implications Of Hypoalbuminemiamentioning

confidence: 99%

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Intravenous Albumin for Mitigating Hypotension and Augmenting Ultrafiltration during Kidney Replacement Therapy

Hryciw

Joannidis

Hiremath

et al. 2021

CJASN

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Among its many functions, owing to its oversized effect on colloid oncotic pressure, intravascular albumin helps preserve the effective circulatory volume. Hypoalbuminemia is common in hospitalized patients and is found especially frequently in patients who require KRT either for AKI or as maintenance hemodialysis. In such patients, hypoalbuminemia is strongly associated with morbidity, intradialytic hypotension, and mortality. Intravenous albumin may be administered in an effort to prevent or treat hypotension or to augment fluid removal, but this practice is controversial. Theoretically, intravenous albumin administration might prevent or treat hypotension by promoting plasma refilling in response to ultrafiltration. However, clinical trials have demonstrated that albumin administration is not nearly as effective a volume expander as might be assumed according to its oncotic properties. Although intravenous albumin is generally considered to be safe, it is also very expensive. In addition, there are potential risks to using it to prevent or treat intradialytic hypotension. Some recent studies have suggested that hyperoncotic albumin solutions may precipitate or worsen AKI in patients with sepsis or shock; however, the overall evidence supporting this effect is weak. In this review, we explore the theoretical benefits and risks of using intravenous albumin to mitigate intradialytic hypotension and/or enhance ultrafiltration and summarize the current evidence relating to this practice. This includes studies relevant to its use in patients on maintenance hemodialysis and critically ill patients with AKI who require KRT in the intensive care unit. Despite evidence of its frequent use and high costs, at present, there are minimal data that support the routine use of intravenous albumin during KRT. As such, adequately powered trials to evaluate the efficacy of intravenous albumin in this setting are clearly needed.

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Section: Safety Of Intravenous Albumin Administrationmentioning

confidence: 99%