Albumin for Treatment of Ascites in Patients With Cirrhosis

This is the authors' abstract. We don't add key points for this paper.

Ascites is the most common complication of cirrhosis and a major landmark in the transition from compensated to decompensated disease. It is associated with impaired quality of life, frequent hospitalizations, and a high risk of further complications, including spontaneous bacterial peritonitis, hyponatremia, and hepatorenal syndrome (HRS). The rationale for albumin administration in patients with cirrhosis and ascites is primarily based on its role as a plasma expander capable of counteracting effective arterial hypovolemia and circulatory dysfunction, although its non‐oncotic properties may also contribute to its clinical effects. Current international guidelines generally support short‐term albumin administration in three major settings related to ascites: prevention of post‐paracentesis circulatory dysfunction after large‐volume paracentesis, spontaneous bacterial peritonitis, and acute kidney injury (AKI). The optimal use and duration of albumin for plasma expansion in HRS‐AKI are currently highly debated, as new observational data have emerged since publication of the most recent consensus. Emerging evidence also suggests a potential role for albumin in the treatment of hypervolemic hyponatremia in cirrhosis, although data are still limited. Long‐term albumin administration represents a distinct therapeutic strategy aimed at improving ascites control and reducing complications. The ANSWER trial showed clinically relevant benefits in selected patients with uncomplicated ascites, whereas discordant findings from other trials indicate that treatment response may be influenced by patient selection, dose, and duration of therapy. More recently, real‐world studies have provided further insights into the feasibility and outcomes of long‐term albumin administration in specific healthcare settings. Overall, albumin remains an important therapeutic option in the management of patients with cirrhosis and ascites. However, its optimal use depends on a personalized approach that considers the patient's overall status, ongoing complications, potential clinical trajectories, and therapeutic goals.