ArticleDigestive diseases and sciences2026
Albumin in the Management of Hepatorenal Syndrome-Acute Kidney Injury: Is There Ever Too Much?
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundConcerns about albumin causing respiratory failure in patients with hepatorenal syndrome-acute kidney injury (HRS-AKI) have caused unease with excess albumin use in these patients.
aimTo assess the outcomes of patients with HRS-AKI who received varying daily albumin doses.
methodsRetrospective study of inpatients with HRS-AKI between Jan 2020 and Apr 2023 collected clinical and laboratory data, AKI treatment, and hospital course with 6-month follow-up. 3 groups of patients such as no albumin, standard albumin (≤ 50 g/day), and high albumin (> 50 g/day) were compared.
results159 AKI episodes were diagnosed in 149 patients (age 60 ± 11 years; male: 63%; MELD-Na: 29 ± 7). 16 AKI episodes received no albumin. Standard and high albumin patients had higher MELD score (p = 0.007) and higher Child-Pugh score (p = 0.057) compared to no albumin group. Standard albumin patients received 40 ± 10 g/day for 6.3 ± 6.5 days, versus 66 ± 14 g/day for 8.5 ± 6.7 days (p < 0.001 and p = 0.055, respectively) in high albumin group. 44 of 54 AKI episodes in high albumin patients had infection as an AKI precipitant (p < 0.001), 67% had stage 3 AKI (p = 0.002 vs. the other 2 groups) with peak creatinine at 403 ± 173 µmol/L, associated with higher rate of AKI progression (p = 0.01), with similar duration of hospital stay compared to the other 2 groups. Respiratory failure occurred in 2 patients in each albumin group related to pneumonia and aspiration. Survival at 6 months was not significantly reduced in the albumin groups (p = 0.141).
conclusionPatients with severe liver dysfunction with HRS-AKI triggered by infection receiving more than recommended albumin dose did not have a more adverse outcome compared to standard albumin dose.
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