Clinical review reveals context-dependent renal outcomes of albumin therapy in critically ill patients, highlighting the need to tailor colloid use to specific clinical settings.
Key Points
To examine the physiological rationale, clinical benefits, and potential harms of intravenous albumin administration on renal outcomes across different critical care settings.
Narrative review evaluating clinical trial and physiological data on iso-oncotic and hyperoncotic albumin formulations.
Evidence synthesized across clinical conditions including septic shock, liver disease, fluid overload requiring diuresis, dialysis-related hypotension, and cardiac surgery.
Albumin administration does not demonstrate superiority over crystalloids or balanced solutions for routine volume resuscitation regarding kidney injury prevention or vasopressor duration.
Evidence supports targeted albumin use to reduce mortality in septic shock with hypoalbuminaemia, manage hepatorenal syndrome, augment diuretic response, and mitigate intradialytic hypotension.
Hyperoncotic albumin infusion increases the risk of acute kidney injury and red blood cell transfusions in high-risk cardiac surgery patients.