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Main clinical trials of albumin in the management of HRS
Study Cohort Results
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
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
The main clinical trials of albumin in SBP
Study Cohort Results
Thevenot et al 2013
Guevara et al 2012
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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