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O’Brien Z, Finnis M, Gallagher M, Bellomo R: Hyperoncotic Albumin Solution in Continuous Renal Replacement Therapy Patients. Blood Purification DOI 10.1159/000517957
A beneficial role for the use of infusions of human serum albumin (iso-oncotic [4%] or hyper-oncotic [20%]) during the management of acute kinder injury (AKI) with continuous renal replacement therapy (CRRT) has been difficult to establish, and the differential impact of iso-oncotic and hyper-oncotic albumin infusions is unknown.
In a post hoc analysis of data generated by the Randomized Evaluation of Normal versus Augmented Level (RENAL) trial of CRRT in AKI, O’Brien et al. evaluated the clinical impact of iso-oncotic and hyper-oncotic serum albumin infusions, or their combinations.
About 51% of the 1,508 subjects enrolled in the RENAL trial received serum albumin infusions: 45% as 4%, 20% as 20%, and 35% as a combination of both 4% and 20% human serum albumin. The characteristics of the subjects receiving human serum albumin infusions were not the same as those who did not – the subjects receiving human serum albumin infusions were generally much sicker. Using a Cox proportional hazard analysis, exposure to 20% human serum albumin infusions was not associated with worse outcomes (90-day mortality or longer recovery time). Administration of 20% human serum albumin was associated with better volume control (less fluid retention). While this post hoc analysis is largely hypothesis generating, it does suggest that hyper-oncotic albumin infusions during CRRT for AKI is not harmful. A randomized clinical trial will be required to establish a clinical role for human serum albumin infusion in terms of efficacy in patients receiving CRRT for severe AKI.
Richard Glassock
Quoted Karger Article
Hyperoncotic Albumin Solution in Continuous Renal Replacement Therapy Patients