Cary H Paine1, Scott W Biggins2,3, Raimund H Pichler4. 1. Division of Nephrology (Kidney-Liver Program), Department of Medicine, University of Washington, 356521, 1959 NE Pacific Street, Seattle, WA, 98195-6521, USA. chpaine@uw.edu. 2. Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA. 3. Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington, Seattle, WA, USA. 4. Division of Nephrology (Kidney-Liver Program), Department of Medicine, University of Washington, 356521, 1959 NE Pacific Street, Seattle, WA, 98195-6521, USA.
Abstract
PURPOSE OF REVIEW: Albumin has repeatedly been shown to be beneficial in treating patients with decompensated cirrhosis. We reviewed the medical literature regarding indications for the use of intravenous albumin in cirrhosis, with particular focus on the ways in which albumin can help mitigate hepatorenal physiology. RECENT FINDINGS: Albumin has long been used as the preferred agent for volume expansion in patients with decompensated cirrhosis. It is used in conjunction with vasoconstrictors for the treatment of type 1 hepatorenal syndrome, and in combination with antibiotics for the treatment of spontaneous bacterial peritonitis. When given at the time of large volume paracentesis, albumin is known to help reduce the incidence of post-paracentesis circulatory dysfunction. Recently, albumin has been shown to improve outcomes in hospitalized patients with cirrhosis and hyponatremia, and has also shown promise in reducing mortality and hospitalizations in outpatients with both diuretic resistant and uncomplicated ascites. It is increasingly clear that these benefits derive from a combination of the oncotic and non-oncotic properties of albumin, and from the effects of albumin administration on effective arterial blood volume. Albumin is an effective treatment for multiple complications encountered in patients with decompensated cirrhosis.
PURPOSE OF REVIEW: Albumin has repeatedly been shown to be beneficial in treating patients with decompensated cirrhosis. We reviewed the medical literature regarding indications for the use of intravenous albumin in cirrhosis, with particular focus on the ways in which albumin can help mitigate hepatorenal physiology. RECENT FINDINGS: Albumin has long been used as the preferred agent for volume expansion in patients with decompensated cirrhosis. It is used in conjunction with vasoconstrictors for the treatment of type 1 hepatorenal syndrome, and in combination with antibiotics for the treatment of spontaneous bacterial peritonitis. When given at the time of large volume paracentesis, albumin is known to help reduce the incidence of post-paracentesis circulatory dysfunction. Recently, albumin has been shown to improve outcomes in hospitalized patients with cirrhosis and hyponatremia, and has also shown promise in reducing mortality and hospitalizations in outpatients with both diuretic resistant and uncomplicated ascites. It is increasingly clear that these benefits derive from a combination of the oncotic and non-oncotic properties of albumin, and from the effects of albumin administration on effective arterial blood volume. Albumin is an effective treatment for multiple complications encountered in patients with decompensated cirrhosis.