Albumin Therapeutic Uses

     
       

 

         
       

There is no evidence that correcting hypoalbuminemia improves outcome, indeed therapeutic albumin administration may worsen outcome.

A number of strategies have utilized albumin as a therapeutic agent:

  1. Correcting hypoalbuminemia to improve outcome – no evidence of improvement.
  2. Using albumin as a hypertonic-hyperoncotic agent to reduce tissue prefusion, with or without diuretics – no evidence of improvement.
  3. For volume replacement in cirrhosis (spontaneous bacterial peritonitis) – some evidence.
  4. As the colloid of choice in infants – no evidence either way.
  5. In burns – no evidence either way.
  6. Following paracentesis for ascites – no evidence.
  7. To treat nephrotic syndrome – no evidence.
  8. As a colloid agent in critical illness: little supportive evidence.

A  meta-analysis by the Cochrane Collaboration (BMJ June 1998), has suggested that the administration of albumin may, in fact, worsen outcome. Whilst this paper was heavily criticized in terms of methodology and outcome measures, it has had a significant impact on practice. A subsequent widened meta-analysis (Wilkes MM 2001) found that albumin administration did not significantly alter outcome.

The inclusion of albumin in “colloid versus crystalloid” debates has led to claims that the latter are safer than the former. However these papers demonstrate the significant weaknesses that exists in the performance of meta-analysis and the geographic bias in publication versus practice.

Why would albumin be harmful?

There are concerns about the manufacturing process of commercially available albumin:

Commercially available albumin is fractionated in ethanol and purified and heat treated for 10 hours at 60oC.

This process:

Probably alters the charge on albumin - making it more permeable.

Contains significant quantities of residual ions - aluminum and vanadium.

It appears that, without strong data supporting the use of this agent, and with alternatives available (hydroxyethyl starch), the continued prescription of albumin as a volume expander is neither clinically indicated nor cost effective. Nonetheless, there is little evidence to reject the use of this agent in it's conventional setting - as a volume expander in babies and in burns. Currently, albumin is the fluid of choice in preventing renal failure in patients with spontaneous bacterial peritonitis (Sort P, 1999).

         
                   
       

         
     

       
       

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