Research Viewpoints Hyper-Oncotic Serum Albumin in CRRT

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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.