Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients: The ALBICS AKI Randomized Clinical Trial
A trial testing concentrated 20% albumin after high-risk cardiac surgery found it did not protect the kidneys and instead increased acute kidney injury, particularly in patients with reduced baseline kidney function.
Background
AKI after cardiac surgery is common and serious. Protein loading appears nephroprotective, so continuous hyperoncotic (20%) albumin infusion was hypothesized to reduce AKI in high-risk patients.
Study design
This investigator-initiated, multicenter, open-label pragmatic RCT at 7 centers in Australia and Italy randomized 611 on-pump cardiac surgery patients within 6 hours after surgery 1:1 to a 300-mL infusion of 20% albumin over 15 hours or usual care, stratified by eGFR above and below 60 mL/min/1.73 m2.
Key findings
AKI occurred in 48.9% of the albumin group versus 43.4% of usual care (unadjusted relative risk 1.13; strata-adjusted relative risk 1.12, 95% CI 1.04-1.21; P=0.003). The effect was more pronounced in patients with eGFR below 60 (adjusted relative risk 1.14).
Clinical implications
These findings do not support routine use of hyperoncotic 20% albumin infusion after high-risk cardiac surgery and suggest potential harm, especially in patients with pre-existing reduced kidney function.
Safety
More blood transfusions were given in the albumin group (37.8% vs 29.9%; P=0.04), with no other significant differences in secondary outcomes.
Category
Research
Source
JAMA Surgery
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