The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Albumin for End-Stage Liver Disease

  • Lee, June-Sung (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine)
  • Published : 2012.03.01
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Abstract

Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. While some of these indications are supported by the results of randomized studies, others are based only on clinical experience and have not been proved in prospective studies. The paucity of well-designed trials, the high cost of albumin, the lack of a clear-cut survival benefit, and fear of transmitting unknown infections make the use of albumin controversial. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect. Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration.

Keywords

References

  1. Gines P, Arroyo V. Is there still a need for albumin infusions to treat patients with liver disease? Gut 2000;46:588-590. https://doi.org/10.1136/gut.46.5.588
  2. Rena NM, Wibawa ID. Albumin infusion in liver cirrhotic patients. Acta Med Indones 2010;42:162-168.
  3. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ 1998;317:235-240. https://doi.org/10.1136/bmj.317.7153.235
  4. Kragh-Hansen U, Chuang VT, Otagiri M. Practical aspects of the ligand-binding and enzymatic properties of human serum albumin. Biol Pharm Bull 2002;25:695-704. https://doi.org/10.1248/bpb.25.695
  5. Evans TW. Review article: albumin as a drug-biological effects of albumin unrelated to oncotic pressure. Aliment Pharmacol Ther 2002;16 Suppl 5:6-11. https://doi.org/10.1046/j.1365-2036.16.s5.2.x
  6. Wong F. Drug insight: the role of albumin in the management of chronic liver disease. Nat Clin Pract Gastroenterol Hepatol 2007;4:43-51. https://doi.org/10.1038/ncpgasthep0680
  7. Quinlan GJ, Margarson MP, Mumby S, Evans TW, Gutteridge JM. Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion. Clin Sci (Lond) 1998;95:459-465. https://doi.org/10.1042/CS19980191
  8. Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology 2005;41:1211-1219. https://doi.org/10.1002/hep.20720
  9. Martin PY, Gines P, Schrier RW. Nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis. N Engl J Med 1998;339:533-541. https://doi.org/10.1056/NEJM199808203390807
  10. Bosch J, Carcia-Pagan J. The splanchnic circulation in cirrhosis. In: Arroyo V, Gines P, Rodes J, Schrier R, eds. Ascites and renal dysfunction in liver disease: pathogenesis, diagnosis and treatment. Malden: Blackwell Science, 1999:330-350.
  11. Arroyo V. Review article: albumin in the treatment of liver diseases-new features of a classical treatment. Aliment Pharmacol Ther 2002;16 Suppl 5:1-5.
  12. Mendez CM, McClain CJ, Marsano LS. Albumin therapy in clinical practice. Nutr Clin Pract 2005;20:314-320. https://doi.org/10.1177/0115426505020003314
  13. Soni N, Margarson M. Albumin, where are we now? Curr Anaesth Crit Care 2004;15:61-68. https://doi.org/10.1016/j.cacc.2004.01.004
  14. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-2256. https://doi.org/10.1056/NEJMoa040232
  15. Wilkes MM, Navickis RJ. Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials. Ann Intern Med 2001;135:149-164. https://doi.org/10.7326/0003-4819-135-3-200108070-00007
  16. Laub R, Strengers P. Parvoviruses and blood products. Pathol Biol (Paris) 2002;50:339-348. https://doi.org/10.1016/S0369-8114(02)00303-6
  17. Laffi G, Gentilini P, Romanelli RG, La Villa G. Is the use of albumin of value in the treatment of ascites in cirrhosis? The case in favour. Dig Liver Dis 2003;35:660-663. https://doi.org/10.1016/S1590-8658(03)00384-0
  18. Gentilini P, Casini-Raggi V, Di Fiore G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol 1999;30:639-645. https://doi.org/10.1016/S0168-8278(99)80194-9
  19. Avidan B. The use of albumin in all patients with decompensated cirrhosis is not justified. Isr Med Assoc J 2005;7:118-120.
  20. Runyon BA. Historical aspects of treatment of patients with cirrhosis and ascites. Semin Liver Dis 1997;17:163-173. https://doi.org/10.1055/s-2007-1007195
  21. Gines P, Tito L, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;94:1493-1502. https://doi.org/10.1016/0016-5085(88)90691-9
  22. Gines A, Fernandez-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002-1010. https://doi.org/10.1016/S0016-5085(96)70068-9
  23. Peltekian KM, Wong F, Liu PP, Logan AG, Sherman M, Blendis LM. Cardiovascular, renal, and neurohumoral responses to single large-volume paracentesis in patients with cirrhosis and diuretic-resistant ascites. Am J Gastroenterol 1997;92:394-399.
  24. Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology 1998;27:264-272. https://doi.org/10.1002/hep.510270139
  25. Follo A, Llovet JM, Navasa M, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994;20:1495-1501. https://doi.org/10.1002/hep.1840200619
  26. Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-409. https://doi.org/10.1056/NEJM199908053410603
  27. Fernandez J, Monteagudo J, Bargallo X, et al. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology 2005;42:627-634. https://doi.org/10.1002/hep.20829
  28. Haynes GR, Navickis RJ, Wilkes MM. Albumin administrationwhat is the evidence of clinical benefit? A systematic review of randomized controlled trials. Eur J Anaesthesiol 2003;20:771-793. https://doi.org/10.1097/00003643-200310000-00003
  29. Faloon WW, Eckhardt RD, Cooper AM, Davidson CS. The effect of human serum albumin, mercurial diuretics, and a low sodium diet on sodium excretion in patients with cirrhosis of the liver. J Clin Invest 1949;28:595-602. https://doi.org/10.1172/JCI102109
  30. McCloy RM, Baldus WP, Maher FT, Summerskill WH. Effects of changing plasma volume, serum albumin concentration, and plasma osmolality on renal function in cirrhosis. Gastroenterology 1967;53:229-239.
  31. Wong PY, Carroll RE, Lipinski TL, Capone RR. Studies on the renin-angiotensin-aldosterone system in patients with cirrhosis and ascites: effect of saline and albumin infusion. Gastroenterology 1979;77:1171-1176.
  32. Angeli P, Albino G, Carraro P, et al. Cirrhosis and muscle cramps: evidence of a causal relationship. Hepatology 1996;23:264-273. https://doi.org/10.1002/hep.510230211
  33. Bataller R, Gines P, Guevara M, Arroyo V. Hepatorenal syndrome. Semin Liver Dis 1997;17:233-247. https://doi.org/10.1055/s-2007-1007201
  34. Guevara M, Gines P, Fernandez-Esparrach G, et al. Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion. Hepatology 1998;27:35-41. https://doi.org/10.1002/hep.510270107
  35. Duvoux C, Zanditenas D, Hezode C, et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study. Hepatology 2002;36:374-380. https://doi.org/10.1053/jhep.2002.34343
  36. Ortega R, Gines P, Uriz J, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 2002;36(4 Pt 1):941-948. https://doi.org/10.1053/jhep.2002.35819
  37. Mitzner SR, Stange J, Klammt S, Peszynski P, Schmidt R, Noldge-Schomburg G. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol 2001;12 Suppl 17:S75-S82.
  38. Jalan R, Williams R. Improvement in cerebral perfusion after MARS therapy: further clues about the pathogenesis of hepatic encephalopathy? Liver Transpl 2001;7:713-715. https://doi.org/10.1053/jlts.2001.26922
  39. Mitzner SR, Stange J, Klammt S, et al. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl 2000;6:277-286. https://doi.org/10.1053/lv.2000.6355
  40. Schmidt LE, Sorensen VR, Svendsen LB, Hansen BA, Larsen FS. Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure. Liver Transpl 2001;7:1034-1039. https://doi.org/10.1053/jlts.2001.29108
  41. Sen S, Davies NA, Mookerjee RP, et al. Pathophysiological effects of albumin dialysis in acute-on-chronic liver failure: a randomized controlled study. Liver Transpl 2004;10:1109-1119. https://doi.org/10.1002/lt.20236
  42. McCormick PA, Mistry P, Kaye G, Burroughs AK, McIntyre N. Intravenous albumin infusion is an effective therapy for hyponatraemia in cirrhotic patients with ascites. Gut 1990;31:204-207. https://doi.org/10.1136/gut.31.2.204
  43. Jalan R, Kapoor D. Reversal of diuretic-induced hepatic encephalopathy with infusion of albumin but not colloid. Clin Sci (Lond) 2004;106:467-474. https://doi.org/10.1042/CS20030357

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