Albumin infusion during dialysis prevents hypotension in hypoalbuminemic patients: Study
USA: The administration of albumin before dialysis in hypoalbuminemic patients (who need hemodialysis) improves fluid removal and results in fewer hypotension episodes, finds a recent study. The findings, published in the journal Critical Care, indicates that albumin infusion is beneficial for improving safety of HD and achieving fluid balance in these high-risk patients.
Intradialytic hypotension (IDH) is a common complication of intermittent hemodialysis (IHD) that occurs from 15 to 50 % of ambulatory sessions. It is more frequent in hospitalized patients with hypoalbuminemia. IDH increases the risk for mortality, early hemodialysis (HD) termination, and risk for vascular access thrombosis. It also limits adequate fluid removal. Etienne Macedo, University of California San Diego, San Diego, CA, USA, and colleagues evaluated the efficacy of albumin infusion for the prevention of IDH during IHD in hypoalbuminemic inpatients.
For the purpose, the researchers performed a randomized, crossover trial in 65 AKI or ESKD patients (mean age 58 (±± 12), and 46 (70%) were male) with hypoalbuminemia (albumin < 3 g/dl) who required HD during hospitalization. Patients were randomized to receive 100 ml of either 0.9%sodium chloride or 25% albumin intravenously at the initiation of each dialysis. The solutions were alternated for upto six sessions. Sixty-five patients were submitted to 249 sessions. Vital signs and ultrafiltration removal rate of the patients were recorded every 15 to 30 min during dialysis.
IDH was assessed by different definitions reported in the literature. All symptoms associated with a noted hypotensive event as well as interventions during the dialysis were recorded.
Key findings of the study include:
- The presence of IDH was lower during albumin sessions based on all definitions.
- The hypotension risk was significantly decreased based on the Kidney Disease Outcomes Quality Initiative definition; (15% with NS vs. 7% with albumin).
- The lowest intradialytic SBP was significantly worse in patients who received 0.9% sodium chloride than albumin (NS 83 vs. albumin 90 mmHg).
- Overall ultrafiltration rate was significantly higher in the albumin therapies [NS − 8.25 ml/kg/h (− 11.18 5.80) vs. 8.27 ml/kg/h (− 12.22 to 5.53) with albumin].
"In hypoalbuminemic patients who need HD, albumin administration before the dialysis results in fewer episodes of hypotension and improves fluid removal. Albumin infusion may be of benefit to improve the safety of HD and achievement of fluid balance in these high-risk patients," wrote the authors.
"A randomized trial of albumin infusion to prevent intradialytic hypotension in hospitalized hypoalbuminemic patients," is published in the journal Critical Care.