Is human albumin solution really the best resuscitation fluid for patients with advanced cirrhosis?

Dear Sirs, We read with interest the revised consensus recommendations for management of acute kidney injury (AKI) ) in cirrhosis by the International Club of Ascites.1 We are concerned that plasma volume expansion only with albumin is recommended for stage 2 and 3 AKI and do not believe that this represents a balanced view of the available evidence. No one doubts that fluid resuscitation is an integral part of the management of AKI; however, studies to date have not established class 1 evidence for an advantage of the use of albumin over other colloids or crystalloids. It can be argued that albumin may represent a superior fluid resuscitation agent in cirrhotic patients. Certainly a recent meta-analysis has confirmed the superiority of albumin compared with artificial plasma expanders for large volume paracentesis.2 Albumin is also recommended for spontaneous bacterial peritonitis supported by a meta-analysis of four...

Source: Gut - July 7, 2016 Category: Gastroenterology Authors: O'Brien, A., China, L., on behalf of the ATTIRE Trial Management Committee, on behalf of the ATTIRE Trial Management Committee, Forrest, Ryder, Wright, Portal, O'Beirne, Shabir, Skene, Chandler, Garcia-Hernandez Tags: PostScript Source Type: research