TABLE 1
Main clinical trials of albumin in the management of HRS
Study Cohort Results
CONFIRM 2021
REVERSE 2017
Patients had HRS-1 with a doubling of the serum creatinine level to at least 2.25mg / dl within 14 days
Patients received intravenous terlipressin 1 – 2mg every 6 hours plus albumin or placebo plus albumin up to 14 days
Terlipressin plus albumin improves kidney function in patients with HRS-1 12
Terlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs . albumin alone in patients with HRS-1 13
TABLE 2
Main clinical trials of albumin in PICD
Study Cohort Results
Arora et al 2020
Alessandria et al 2011
80 acute on chronic liver failure patients undergoing < 5l paracentesis were randomised to receive albumin ( 8g / dl ascitic fluid ) or no albumin and serially detected for PICD
Seventy cirrhotic patients treated with LVP were randomised to receive IV albumin : group 1 received 4g albumin per l of ascites removed , group 2 received 8g / l of ascites removed
Albumin infusion decreases the incidence of PICD and mortality among patients with ACLF 14
Treatment with a low dose of albumin is effective in the prevention of PICD 17
TABLE 3
The main clinical trials of albumin in SBP
Study Cohort Results
Thevenot et al 2013
Guevara et al 2012
INFECIR-2
Patients with sepsis unrelated to SBP , antibiotics plus albumin ( 1.5g / kg on day 1 and 1g / kg on day 3 )
A total of 110 patients with cirrhosis hospitalised for infections other than SBP were randomly assigned to receive antibiotics plus albumin ( 1.5g / kg BW at diagnosis and 1g / kg BW at day 3 )
A total of 118 patients with cirrhosis with non-SBP infections and additional risk factors for poor outcome were randomly assigned to receive antibiotics plus albumin or antibiotics alone
Antibiotics plus albumin ( 1.5g / kg on day 1 and 1g / kg on day 3 ) was superior to antibiotics alone in delaying renal failure 20
Albumin reduces circulatory haemodynamics by reducing PRA and norepinephrine concentrations while increasing the atrial natriuretic factor , resulting in improved survival 21
Patients given albumin were sicker at baseline , but during the follow-up period a higher proportion had ACLF resolution and a lower ratio for nosocomial infections 22
GETTY cirrhosis . 10 Patients with cirrhosis present with hypoalbuminaemia , mainly attributed to a decreased capacity for synthesising albumin , but the condition is believed to be multifactorial . Albumin production is reduced due to liver dysfunction and abnormal portal blood flow distribution . 10
There are established indications for administering human albumin among patients with severe liver diseases and resultant complications .
Prevention and treatment of hepatorenal syndrome Hepatorenal syndrome ( HRS ) is defined as renal dysfunction that occurs because of reduced renal perfusion , haemodynamic alterations in the arterial circulation , and overactivity of the endogenous vasoactive systems . 11 HRS has two distinct types .
Type I HRS ( HRS-1 ) occurs due to rapid reduction in renal function , defined by a doubling of the serum creatinine to a level > 2.5mg / dl or a 50 % reduction of the initial 24 h creatinine clearance to a level lower than 20ml / min in less than two weeks . 6 Type 2 HRS ( HRS-2 ) occurs due to renal dysfunction that does not progress rapidly and is associated with refractory ascites , representing the main clinical problem . 11
HRS occurs as an after-effect of a reduction in the effective circulating volume . An aetiopathogenesis is the splanchnic and systemic arterial vasodilation resulting in a decrease in renal perfusion due to inadequate cardiac output . Studies show that systemic vasoconstrictors and intravenous albumin lead to
11 – 13 favourable outcomes . The main clinical trials of albumin in the management
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